Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 036.122446 | IL |
Y | 207XS0117X | Orthopaedic Spine Surgeon | 036-122446 | IL |
NPI | 1255317194 |
---|---|
Provider Name | Mir H Ali |
First Address | Morris, IL 60450-1207 |
Second Address | Morris, IL 60450-4200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2005 |
Last Update Date | 06/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036.122446 | LICENSE (01) | IL |
I38911 | (02) |