MEDICARE: SYLVEENA E. ALI DO

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	207Q00000X	Family Medicine Physician	036096789	IL

General Provider Information

NPI Number	:	1134174931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYLVEENA E. ALI DO

Provider Business Mailing Address
First Line	:	2650 RIDGE AVE STE 1223
Second Line	:
City	:	EVANSTON
State	:	IL
Zip	:	60201-1700
Country	:	US
Telephone Number	:	847-982-6715
Fax Number	:	847-982-3394

Provider Business Practice Location Address
First Line	:	5346 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-2120
Country	:	US
Telephone Number	:	773-293-8880
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	11/08/2021

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