Individual
DR. ALI WASITI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20201 CRAWFORD AVE, OLYMPIA FIELDS, IL 60461
(708) 747-4000
Mailing address
36123 SCHOOLCRAFT RD, LIVONIA, MI 48150-1216
(734) 793-6140
(865) 560-8948
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01073249A
IN
207R00000X
Internal Medicine Physician
036126242
IL
208M00000X
Hospitalist Physician
Primary
036126242
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036126242
STATE LICENSE
IL
05
—
036126242
—
IL
01
—
IL5686069
MEDICARE PTAN
IL
Enumeration date
08/28/2008
Last updated
05/11/2021
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