MEDICARE: SYED A ALI MD

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	01026430A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528055662
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYED A ALI MD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2005
Last Update Date	:	10/25/2007

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