Basic Information
| Provider Information | |||||||||
| NPI: | 1598974123 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALSOROGI | ||||||||
| FirstName: | MOHAMMAD | ||||||||
| MiddleName: | SAEED | ||||||||
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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: | 201 E GRAY ST | ||||||||
| Address2: | SUITE 1003 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292602 | ||||||||
| FaxNumber: | 5026292603 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 12/31/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/31/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084N0400X | 41828 | KY | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 2084V0102X | 41828 | KY | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Vascular Neurology |
ID Information
| ID | Type | State | Issuer | Description | 000057058DD | 01 | KY | HUMANA - NNS | OTHER | 6708250 | 01 | KY | CIGNA - NNS | OTHER | 50030637 | 01 | KY | PASSPORT & PASSPORT ADVANTAGE - NNS | OTHER | 7100060980 | 05 | KY | MEDICAID | 000000693356 | 01 | KY | ANTHEM - NNS | OTHER | 119119 | 01 | KY | SIHO - NNS | OTHER |