Basic Information
Provider Information | |||||||||
NPI: | 1073587143 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ALI | ||||||||
FirstName: | MUHAMMAD | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 936 | ||||||||
Address2: |   | ||||||||
City: | LONDON | ||||||||
State: | KY | ||||||||
PostalCode: | 407430936 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6063307818 | ||||||||
FaxNumber: | 6063307825 | ||||||||
Practice Location | |||||||||
Address1: | 378 THOMPSON POYNTER RD | ||||||||
Address2: |   | ||||||||
City: | LONDON | ||||||||
State: | KY | ||||||||
PostalCode: | 407417238 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6068773990 | ||||||||
FaxNumber: | 6068773993 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 02/15/2006 | ||||||||
LastUpdateDate: | 05/03/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 35949 | KY | Y |   | Allopathic & Osteopathic Physicians | Pediatrics |   |
ID Information
ID | Type | State | Issuer | Description | 61-1427889 | 01 | KY | BLUEGRASS FAMILY HEALTH | OTHER | 030670000 | 01 | KY | BLACK LUNG | OTHER | 61-1427889 | 01 | KY | TRICARE | OTHER | C12807 | 01 | KY | CUMBERLAND HEALTHCARE INC | OTHER | 61-1427889 | 01 | KY | HUMANA | OTHER | 61-1427889 | 01 | KY | CHA | OTHER | 50005617 | 01 | KY | PASSPORT HEALTH PLAN | OTHER | 61-1427889 | 01 | KY | UHC | OTHER | 000000377917 | 01 | KY | ANTHEM PROVIDER # | OTHER | 64017478 | 05 | KY |   | MEDICAID |