DR. SYED MASOOD ALI M.D. NPI 1700805439

Family Medicine in Peoria, IL

About SYED ALI

Syed Ali is a provider in Peoria, IL with more than 51 years of experience. The NPI number assigned to this provider is 1700805439. The practitioner's primary taxonomy code is Family Medicine (207Q00000X). The provider is registered as an individual and their NPI record was last updated 10 years ago. Syed Ali is registered with Medicare and accepts claims assignment.

NPI1700805439 Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. SYED MASOOD ALI M.D.
Provider Location Address4930 N EXECUTIVE DR PEORIA, IL 61614 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address4930 N EXECUTIVE DR PEORIA, IL 61614 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Medical School NameOTHER
Graduation Year1967
Is Sole Proprietor?Yes
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date07-19-2006 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date01-10-2008 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. SYED MASOOD ALI M.D.
4930 N EXECUTIVE DR
PEORIA, IL
ZIP 61614
Phone: (309) 691-3707
Fax: (309) 692-0270
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Mailing Address

DR. SYED MASOOD ALI M.D.
4930 N EXECUTIVE DR
PEORIA, IL
ZIP 61614
Phone: (309) 691-3707
Fax: (309) 692-0270

Primary Taxonomy

Taxonomy Code207Q00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationFamily Medicine
TypeAllopathic & Osteopathic Physicians
License StateIL
Taxonomy DescriptionFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
212719OTHER (01)IL
K23331MEDICARE PIN (08)IL
E-10696MEDICARE UPIN (02)IL

Map Location


DR. SYED MASOOD ALI M.D. address is 4930 N EXECUTIVE DR PEORIA, IL 61614

Other Providers at the same location


The following 4 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1689896961SYED MASOOD ALI, MDSC
Organization
General Practice4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 692-7575
1699839985PEORIA INTEGRATIVE MEDICAL CENTER LTD
Organization
Family Medicine4930 N EXECUTIVE DR SUITE B
PEORIA, IL 61614
(309) 683-6002
1801874565 MAQBOOL B ALI M.D
Individual
Surgery4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 692-7575
1912129271GREATER PEORIA OBSTETRICS & GYNECOLOGY CORP SC
Organization
Specialist4930 N EXECUTIVE DR
PEORIA, IL 61614
(309) 671-8749