Provider Demographics
NPI:1679033450
Name:GILLANI, SYED ALI RAZA (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:ALI RAZA
Last Name:GILLANI
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 1:6560 FANNIN ST STE 802
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2726
Mailing Address - Country:US
Mailing Address - Phone:713-363-9589
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR # CE514
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-2726
Practice Address - Country:US
Practice Address - Phone:347-659-5430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125073826207R00000X
IL125.073826390200000X
390200000X
MO2023010810390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine