Healthcare Provider Details

I. General information

NPI: 1053932848
Provider Name (Legal Business Name): SAJA MUSTAFA ALI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2020
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19550 GOVERNORS HWY STE 2200
FLOSSMOOR IL
60422-2137
US

IV. Provider business mailing address

19550 GOVERNORS HWY STE 2200
FLOSSMOOR IL
60422-2137
US

V. Phone/Fax

Practice location:
  • Phone: 708-915-3100
  • Fax: 708-915-8720
Mailing address:
  • Phone: 708-915-3100
  • Fax: 708-915-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number036176187
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: