Provider Demographics
NPI:1588664775
Name:ALI, SYED V (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:V
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2603 ELECTRIC AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PORT HURON
Mailing Address - State:MI
Mailing Address - Zip Code:48060-6588
Mailing Address - Country:US
Mailing Address - Phone:810-824-4198
Mailing Address - Fax:810-824-4785
Practice Address - Street 1:2603 ELECTRIC AVE STE 1
Practice Address - Street 2:
Practice Address - City:PORT HURON
Practice Address - State:MI
Practice Address - Zip Code:48060-6588
Practice Address - Country:US
Practice Address - Phone:810-824-4198
Practice Address - Fax:810-824-4785
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301078992207RS0012X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1588664775Medicaid
G74119Medicare UPIN
MIMI6992Medicare PIN