Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 019.031485 | IL |
Y | 213EG0000X | General Practice | 019.031485 | IL |
NPI | 1003322520 |
---|---|
Provider Name | Amjad Ali |
First Address | Chicago, IL 60654-4782 |
Second Address | Midland, TX 79707-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2017 |
Last Update Date | 19/01/2018 |