MEDICARE: WAQAS ALI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	35134	IA
2	207RI0200X	Infectious Disease Physician	35134	IA
3	207R00000X	Internal Medicine Physician	036118103	IL
4	208M00000X	Hospitalist Physician	036118103	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00052139	OTHER	IA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023094190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WAQAS ALI MD

Provider Business Mailing Address
First Line	:	5100 RELIABLE PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0001
Country	:	US
Telephone Number	:	309-672-4809
Fax Number	:

Provider Business Practice Location Address
First Line	:	221 NE GLEN OAK AVE
Second Line	:
City	:	PEORIA
State	:	IL
Zip	:	61636-0001
Country	:	US
Telephone Number	:	309-672-5522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	03/07/2013

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Directions to “ WAQAS ALI MD” Practice Location

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