Provider Demographics
NPI:1417963612
Name:ALI, SYED (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:
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 1:1751 S NAPERVILLE RD
Mailing Address - Street 2:207
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60189-5896
Mailing Address - Country:US
Mailing Address - Phone:630-690-2222
Mailing Address - Fax:
Practice Address - Street 1:1751 S NAPERVILLE RD
Practice Address - Street 2:207
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5896
Practice Address - Country:US
Practice Address - Phone:630-690-2222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2009-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL03360165492084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry