Healthcare Provider Details

I. General information

NPI: 1982997342
Provider Name (Legal Business Name): SYED UMER ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 01/06/2023
Certification Date: 01/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 N CALIFORNIA ST STE 14A
STOCKTON CA
95204-3760
US

IV. Provider business mailing address

2800 N CALIFORNIA ST STE 14A
STOCKTON CA
95204-3760
US

V. Phone/Fax

Practice location:
  • Phone: 209-942-1005
  • Fax: 209-942-0455
Mailing address:
  • Phone: 209-942-1005
  • Fax: 209-942-0455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberP9290
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number63692
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberA161537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: