Healthcare Provider Details

I. General information

NPI: 1083403646
Provider Name (Legal Business Name): SYED HASAN ALI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2025
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date: 02/17/2026
Reactivation Date: 05/20/2026

III. Provider practice location address

1200 CHILDREN'S AVENUE A2, SUITE 14402
OKLAHOMA CITY OK
73104
US

IV. Provider business mailing address

1200 CHILDRENS AVE,A2, SUITE 14402
OKLAHOMA CITY OK
73104
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-4417
  • Fax: 405-271-2920
Mailing address:
  • Phone: 405-271-4417
  • Fax: 405-271-2920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number45709
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: