Provider Demographics
NPI:1750496055
Name:ALI, SYED S (MD)
Entity Type:Individual
Prefix:
First Name:SYED
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6828 STATE ROUTE 162
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-8558
Mailing Address - Country:US
Mailing Address - Phone:618-288-5906
Mailing Address - Fax:618-288-5914
Practice Address - Street 1:6828 STATE ROUTE 162
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-8558
Practice Address - Country:US
Practice Address - Phone:618-288-5906
Practice Address - Fax:618-288-5914
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL36638302084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL231060Medicare ID - Type Unspecified
ILG25340Medicare UPIN