Provider Demographics
NPI:1376528919
Name:ANSARI, ASIMUL (MD)
Entity Type:Individual
Prefix:
First Name:ASIMUL
Middle Name:
Last Name:ANSARI
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 637334
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7334
Mailing Address - Country:US
Mailing Address - Phone:513-745-9800
Mailing Address - Fax:513-246-4050
Practice Address - Street 1:10525 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4401
Practice Address - Country:US
Practice Address - Phone:513-745-9800
Practice Address - Fax:513-246-5040
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036111559207RC0000X
OH35120477207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH287370Medicare PIN
H93991Medicare UPIN