Basic Information
| Provider Information | |||||||||
| NPI: | 1144227026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ISMAIL | ||||||||
| FirstName: | ASAD | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 720 W BROADWAY STE 202 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025610943 | ||||||||
| FaxNumber: | 5025610944 | ||||||||
| Practice Location | |||||||||
| Address1: | 645 S ROY WILKINS AVE STE 200 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402032072 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025610520 | ||||||||
| FaxNumber: | 5026538181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 11/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 01050254A | IN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084P0800X | 34174 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | 01050254A | IN | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084A0401X | 01050254A | IN | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Addiction Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2444451000 | 01 | KY | PASSPORT GROUP | OTHER | 78903689 | 05 | KY | MEDICAID | CG3623 | 01 | IN | RAILROAD MEDICARE GROUP | OTHER | P00127309 | 01 | IN | MEDICARE RAILROAD | OTHER | 000000056294 | 01 | ANTHEM GROUP | OTHER | 000000328529 | 01 | ANTHEM | OTHER | 6764 | 01 | KY | MEDICARE GROUP | OTHER | 160860 | 01 | IN | MEDICARE GROUP | OTHER | CK2274 | 01 | KY | RAILROAD MEDICARE GROUP | OTHER | 130025311 | 01 | KY | MEDICARE RAILROAD | OTHER | 65927857 | 05 | KY | MEDICAID | 1063415297 | 01 | GROUP NPI | OTHER | 160780 | 01 | IN | MEDICARE GROUP | OTHER | 200244600A | 05 | IN | MEDICAID | 214446000 | 01 | MAGELLAN MIS | OTHER | 2699709000 | 01 | KY | PASSPORT ADVANTAGE | OTHER | 64342744 | 05 | KY | MEDICAID | 100386460 | 01 | IN | MEDICAID GROUP | OTHER | 50704000 | 01 | MAGELLAN MIS | OTHER | 82900176 | 05 | KY | MEDICAID |