Provider Demographics
NPI:1578547402
Name:AL-ANI, ISMAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ISMAIL
Middle Name:
Last Name:AL-ANI
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 1:3245 HEALTH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-1380
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:621 MEMORIAL DR STE 512
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1075
Practice Address - Country:US
Practice Address - Phone:574-246-9350
Practice Address - Fax:574-246-9370
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053640A207RP1001X, 207RC0200X, 207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200479040Medicaid
IN200479040Medicaid
IN000000346693OtherBLUE CROSS BLUE SHIELD
INP00243854OtherRAILROAD MEDICARE
IN211770CMedicare PIN
IN941050PPPPMedicare PIN