Individual
MIR M ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1800 HOLLISTER DR STE 112, LIBERTYVILLE, IL 60048-5265
(847) 367-6781
Mailing address
1800 HOLLISTER DR STE 112, LIBERTYVILLE, IL 60048-5265
(847) 367-6781
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01070723A
IN
207R00000X
Internal Medicine Physician
148315
CA
207R00000X
Internal Medicine Physician
276959
NY
207RH0003X
Hematology & Oncology Physician
Primary
036.152740
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201060520
—
IN
Enumeration date
01/09/2012
Last updated
12/16/2021
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