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General NPI Number Information
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NPI Number | 1396026506
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Entity Type | Individual
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Provider Name | ABDULMONAM AHMAD ABULGASEM ALI M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 4106 S WATER TOWER PL
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City | MOUNT VERNON
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State | IL
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Zip | 62864-6544
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Country | US
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Telephone | 618-242-8900
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Fax |
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Provider Business Mailing Address
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Address Line | 4501 HAMMERBERSLY RD APT 10G
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City | MADISON
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State | WI
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Zip | 53711
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 1721
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 036.142644
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 1721
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License Number State | WI
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Taxonomy #4
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Taxonomy Code | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | 036142644
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License Number State | IL
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