Organization Name: | SYED MASOOD ALI, MDSC |
NPI Number: | 1689896961 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUSAN LAFOLLETTE (BILLING MANAGER) |
Mailing Address: | 4930 N Executive Dr Peoria |
State: | IL US |
Postal Code: | 616144894 |
Phone Number: | 3096927575 |
Fax Number: | |
NPI Enumeration Date: | 05/03/2007 |
NPI Last Update Date: | 06/30/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 036067626 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |