Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 01083839 | IN |
N | 111NI0900X | Internist | 01083839 | IN |
Y | 207R00000X | Internist | 01083839A | IN |
Y | 111NI0900X | Internist | 01083839A | IN |
N | 207R00000X | Internist | 56061 | CT |
N | 111NI0900X | Internist | 56061 | CT |
NPI | 1003255498 |
---|---|
Provider Name | Dr. Ishaque Ali Syed |
First Address | Fort Wayne, IN 46845-1703 |
Second Address | Fort Wayne, IN 46845-1701 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2013 |
Last Update Date | 15/07/2020 |