MEDICARE: SYED R ALI

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	291U00000X	Clinical Medical Laboratory	14D2263216	IL

General Provider Information

NPI Number	:	1437882321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED R ALI

Provider Business Mailing Address
First Line	:	437 VICTORIA LN
Second Line	:
City	:	GLENDALE HEIGHTS
State	:	IL
Zip	:	60139-4510
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3525 W PETERSON AVE STE 117
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60659-3313
Country	:	US
Telephone Number	:	312-722-6925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	07/07/2022

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