Provider Demographics
NPI:1174636435
Name:ALI, SYED IRFAN QASIM (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:IRFAN QASIM
Last Name:ALI
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 1:2321 OLYMPIA DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-1856
Mailing Address - Country:US
Mailing Address - Phone:972-350-0225
Mailing Address - Fax:972-350-0228
Practice Address - Street 1:2321 OLYMPIA DR STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-1856
Practice Address - Country:US
Practice Address - Phone:972-350-0225
Practice Address - Fax:972-350-0228
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA253466207L00000X
ME018016207Q00000X, 208M00000X
TXQ6140207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432681599Medicaid