Healthcare Provider Details

I. General information

NPI: 1700152048
Provider Name (Legal Business Name): ALI MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MEDICAL PLZ STE 100
LAKE ST LOUIS MO
63367-1484
US

IV. Provider business mailing address

300 MEDICAL PLZ STE 100
LAKE ST LOUIS MO
63367-1484
US

V. Phone/Fax

Practice location:
  • Phone: 630-952-1412
  • Fax:
Mailing address:
  • Phone: 630-952-1412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State

VIII. Authorized Official

Name: QAISER JAWAID
Title or Position: MEMBER
Credential: M.D
Phone: 630-952-1412