MEDICARE: GHOUSIA BEGUM 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	207QA0000X	Adolescent Medicine (Family Medicine) Physician	036084980	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	:	1518969518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GHOUSIA BEGUM ALI MD

Provider Business Mailing Address
First Line	:	5800 KEENEY ST
Second Line	:
City	:	MORTON GROVE
State	:	IL
Zip	:	60053-3551
Country	:	US
Telephone Number	:	847-674-6611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2136 W DEVON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-2127
Country	:	US
Telephone Number	:	773-274-3060
Fax Number	:

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	06/11/2010

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