Basic Information
| Provider Information | |||||||||
| NPI: | 1053422642 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AJMANI | ||||||||
| FirstName: | DEEP | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 E CHESTNUT ST | ||||||||
| Address2: | SERVICES BLDG, STE 303 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026295552 | ||||||||
| FaxNumber: | 5026293132 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 04/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36867 | KY | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 01054037A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 36867 | KY | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 64051717 | 05 | KY | MEDICAID | 3933147 | 01 | KY | CIGNA - NICS | OTHER | 053263 | 01 | KY | SIHO - NICS | OTHER | 200539510 | 05 | IN | MEDICAID | 50025232 | 01 | KY | PASSPORT - NICS | OTHER | 000000623994 | 01 | KY | ANTHEM - NICS | OTHER | 3731183000 | 01 | KY | PASSPORT ADVANTAGE - NICS | OTHER | 000023036C | 01 | KY | HUMANA - NICS | OTHER |