Provider Demographics
NPI:1225123615
Name:ALI, SYED F (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:F
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:PO BOX 7198
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60181-7198
Mailing Address - Country:US
Mailing Address - Phone:630-599-7550
Mailing Address - Fax:630-405-0121
Practice Address - Street 1:161 S LINCOLNWAY STE 210
Practice Address - Street 2:
Practice Address - City:NORTH AURORA
Practice Address - State:IL
Practice Address - Zip Code:60542-1660
Practice Address - Country:US
Practice Address - Phone:630-599-7550
Practice Address - Fax:630-405-0121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041640207R00000X
IL036-106803208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL11141819OtherCAQH
IL11141819OtherCAQH
WAH69771Medicare UPIN