Healthcare Provider Details

I. General information

NPI: 1205825924
Provider Name (Legal Business Name): SYED A ALI MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 10/25/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MILLIS AVE
BOONVILLE IN
47601-2329
US

IV. Provider business mailing address

PO BOX 467
BOONVILLE IN
47601-0467
US

V. Phone/Fax

Practice location:
  • Phone: 812-897-4458
  • Fax: 812-897-5977
Mailing address:
  • Phone: 812-897-4458
  • Fax: 812-897-5977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SYED A ALI
Title or Position: PRESIDENT
Credential: MD
Phone: 812-897-4458