MEDICARE: DR. SYED ALI RAZA GILLANI 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	390200000X	Student in an Organized Health Care Education/Training Program	2023010810	MO
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084N0400X	Neurology Physician	ME178237	FL
4	390200000X	Student in an Organized Health Care Education/Training Program	125.073826	IL
5	207R00000X	Internal Medicine Physician	125073826	IL

General Provider Information

NPI Number	:	1679033450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SYED ALI RAZA GILLANI MD

Provider Business Mailing Address
First Line	:	2300 E COUNTY ROAD 540A FL 2
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3825
Country	:	US
Telephone Number	:	321-841-7550
Fax Number	:	321-841-8185

Provider Business Practice Location Address
First Line	:	2300 E COUNTY ROAD 540A FL 2
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-3825
Country	:	US
Telephone Number	:	321-841-7550
Fax Number	:	321-841-8185

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

Provider Enumeration Date	:	03/20/2019
Last Update Date	:	06/01/2026

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