MEDICARE: DR. IMRAN WAJID ALI M.D.

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	207RC0000X	Cardiovascular Disease Physician	036114351	IL

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	:	1235162025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IMRAN WAJID ALI M.D.

Provider Business Mailing Address
First Line	:	7447 W TALCOTT AVE STE 222
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3713
Country	:	US
Telephone Number	:	773-774-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	7447 W TALCOTT AVE STE 222
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-3713
Country	:	US
Telephone Number	:	773-774-5245
Fax Number	:

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

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	10/13/2020

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