Healthcare Provider Details

I. General information

NPI: 1851080584
Provider Name (Legal Business Name): OSAMA ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2023
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S MADISON ROAD
BELOIT WI
53511
US

IV. Provider business mailing address

1905 E HUEBBE PKWY
BELOIT WI
53511-1842
US

V. Phone/Fax

Practice location:
  • Phone: 608-364-2293
  • Fax:
Mailing address:
  • Phone: 608-364-2293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number87691-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: