Individual
MAQBOOL B ALI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D
Contact information
Practice address
4930 N EXECUTIVE DR, PEORIA, IL 61614-4894
(309) 692-7575
(309) 692-0275
Mailing address
4930 N EXECUTIVE DR, PEORIA, IL 61614-4894
(309) 692-7575
(309) 692-0275
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036058850
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
212742
MEDICARE GROUP NUMBER
IL
Enumeration date
01/04/2006
Last updated
01/10/2008
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