Provider Demographics
NPI:1063479319
Name:ALBAGHDADI, ALI S (MD)
Entity type:Individual
Prefix:DR
First Name:ALI
Middle Name:S
Last Name:ALBAGHDADI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2745 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:IA
Mailing Address - Zip Code:52732-7201
Mailing Address - Country:US
Mailing Address - Phone:563-244-2144
Mailing Address - Fax:563-244-2143
Practice Address - Street 1:2745 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-7201
Practice Address - Country:US
Practice Address - Phone:563-244-2144
Practice Address - Fax:563-244-2143
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-1123608207RC0000X
WI171-320207RC0000X
FLME167732207RC0000X
IA36145207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
247143OtherMIDLANDS CHOICE
39841OtherWELLMARK BC/BS
IA0462366Medicaid
110992OtherHEALTH ALLIANCE
247143OtherMIDLANDS CHOICE
P00259160Medicare PIN
247143OtherMIDLANDS CHOICE
IAI15583Medicare PIN