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Individual

SYED ALI SHAN IDRIS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.; MBBS

Contact information

Practice address
5965 EASY BROAD STREET, SUITE 260, COLUMBUS, OH 43213
(641) 866-3703
(614) 866-6109
Mailing address
5965 E BROAD ST STE 260, COLUMBUS, OH 43213-1562
(641) 866-3703
(614) 866-6109

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
35.087057
OH
207R00000X
Internal Medicine Physician
35087057
OH
208000000X
Pediatrics Physician
35.087057
OH
208000000X
Pediatrics Physician
35087057
OH
2084N0400X
Neurology Physician
Primary
35.087057
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000494609
ANTHEM
OH
05
2697489
OH
01
P00352662
RAILROAD
OH
Enumeration date
08/24/2006
Last updated
09/08/2014
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