MEDICARE: SYED A ALI MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1205825924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYED A ALI MD INC

Provider Business Mailing Address
First Line	:	PO BOX 467
Second Line	:
City	:	BOONVILLE
State	:	IN
Zip	:	47601-0467
Country	:	US
Telephone Number	:	812-897-4458
Fax Number	:	812-897-5977

Provider Business Practice Location Address
First Line	:	1301 MILLIS AVE
Second Line	:
City	:	BOONVILLE
State	:	IN
Zip	:	47601-2329
Country	:	US
Telephone Number	:	812-897-4458
Fax Number	:	812-897-5977

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SYED A ALI
Credential	:	MD
Telephone Number	:	812-897-4458

Provider Enumeration Date	:	10/14/2005
Last Update Date	:	10/25/2007

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