Provider Demographics
NPI:1073587143
Name:ALI, MUHAMMAD (MD)
Entity Type:Individual
Prefix:
First Name:MUHAMMAD
Middle Name:
Last Name:ALI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:606-330-7818
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:378 THOMPSON POYNTER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7238
Practice Address - Country:US
Practice Address - Phone:606-877-3990
Practice Address - Fax:606-877-3993
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35949208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY61-1427889OtherBLUEGRASS FAMILY HEALTH
KY030670000OtherBLACK LUNG
KY61-1427889OtherTRICARE
KYC12807OtherCUMBERLAND HEALTHCARE INC
KY61-1427889OtherHUMANA
KY61-1427889OtherCHA
KY50005617OtherPASSPORT HEALTH PLAN
KY61-1427889OtherUHC
KY000000377917OtherANTHEM PROVIDER #
KY64017478Medicaid
KY61-1427889OtherCHA
KYG53719Medicare UPIN