MEDICARE: DR. ABDULMONAM AHMAD ABULGASEM 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	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	1721	WI
2	207RP1001X	Pulmonary Disease Physician	036.142644	IL
3	207RP1001X	Pulmonary Disease Physician	1721	WI
4	207RC0200X	Critical Care Medicine (Internal Medicine) Physician	036142644	IL

General Provider Information

NPI Number	:	1396026506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ABDULMONAM AHMAD ABULGASEM ALI M.D.

Provider Business Mailing Address
First Line	:	4501 HAMMERBERSLY RD APT 10G
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53711
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4106 S WATER TOWER PL
Second Line	:
City	:	MOUNT VERNON
State	:	IL
Zip	:	62864-6544
Country	:	US
Telephone Number	:	618-242-8900
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	07/19/2023

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