Basic Information
| Provider Information | |||||||||
| NPI: | 1598739617 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALI | ||||||||
| FirstName: | AMJAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 740 E LAUREL RD | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 407418601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068773931 | ||||||||
| FaxNumber: | 6068773978 | ||||||||
| Practice Location | |||||||||
| Address1: | 310 E 9TH ST | ||||||||
| Address2: | |||||||||
| City: | LONDON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40741 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068786520 | ||||||||
| FaxNumber: | 6068773978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 10/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 01081762A | IN | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 01081762A | IN | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | 34288 | KY | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 34288 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 64027303 | 05 | KY | MEDICAID | 611427889 | 01 | KY | BLUEGRASS FAMILY HEALTHCA | OTHER | K237232 | 01 | KY | MEDICARE | OTHER | 030670000 | 01 | KY | BLACK LUNG | OTHER | 611427889 | 01 | KY | UNITED HEALTHCARE | OTHER | 50005623 | 01 | KY | PASSPORT HEALTHCARE | OTHER | C72032 | 01 | KY | CUMBERLAND HEALTHCARE INC | OTHER | 611427889 | 01 | KY | CHA | OTHER | 611427889 | 01 | KY | HUMANA | OTHER | 930124013 | 01 | KY | RAILROAD MEDICARE | OTHER | 000000377977 | 01 | KY | ANTHEM PROVIDER # | OTHER | 611427889 | 01 | KY | TRICARE | OTHER |