Provider Demographics
NPI:1659453348
Name:AL-SHAMI, NADIR HANNA (MD)
Entity Type:Individual
Prefix:
First Name:NADIR
Middle Name:HANNA
Last Name:AL-SHAMI
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 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-272-5100
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:9340 CEDAR CENTER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40291-4522
Practice Address - Country:US
Practice Address - Phone:502-239-8431
Practice Address - Fax:502-239-8399
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY17864207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000712470OtherANTHEM - NICC
KY1050555OtherPASSPORT
KY64178643Medicaid
KY127537OtherSIHO - NICC
000000046149Medicare ID - Type Unspecified
KY127537OtherSIHO - NICC
KY1050555OtherPASSPORT
E01507Medicare UPIN