Healthcare Provider Details

I. General information

NPI: 1376390948
Provider Name (Legal Business Name): MR. MUHAMMAD ALI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2024
Last Update Date: 05/02/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W. 95TH STREET, OAK LAWN IL
OAK LAWN IL
60453
US

IV. Provider business mailing address

1775 DEMPSTER STREET, 8 SOUTH, MAILBOX #48 OFFICE OF ME
PARK RIDGE IL
60068
US

V. Phone/Fax

Practice location:
  • Phone: 708-346-4055
  • Fax:
Mailing address:
  • Phone: 847-723-2210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: