Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 036118103 | IL |
N | 111NI0900X | Internist | 036118103 | IL |
Y | 207R00000X | Internist | 35134 | IA |
Y | 111NI0900X | Internist | 35134 | IA |
N | 207RI0200X | Infectious Disease | 35134 | IA |
NPI | 1023094190 |
---|---|
Provider Name | Waqas Ali |
First Address | Chicago, IL 60686-0001 |
Second Address | Peoria, IL 61636-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2005 |
Last Update Date | 07/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0297184 | (05) | IA |
H90384 | (02) | IA |
P00052139 | RR MEDICARE (01) | IA |