Healthcare Provider Details

I. General information

NPI: 1174459499
Provider Name (Legal Business Name): MUSTAFA MEER ALI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 N WALL ST
KANKAKEE IL
60901-3483
US

IV. Provider business mailing address

7045 N KEATING AVE
LINCOLNWOOD IL
60712-2122
US

V. Phone/Fax

Practice location:
  • Phone: 815-933-1671
  • Fax:
Mailing address:
  • Phone: 551-795-7761
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.088682
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: