Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 019.032092 | IL |
NPI | 1518528165 |
---|---|
Provider Name | Dr. Ali Al-Qudsi |
First Address | Chicago, IL 60612-3714 |
Second Address | Chicago, IL 60612-3714 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2019 |
Last Update Date | 07/08/2019 |