Provider Demographics
NPI:1861668402
Name:ALI, BUSHRA K (MD)
Entity Type:Individual
Prefix:MRS
First Name:BUSHRA
Middle Name:K
Last Name:ALI
Suffix:
Gender:F
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 8440
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-0440
Mailing Address - Country:US
Mailing Address - Phone:419-725-2527
Mailing Address - Fax:419-725-2528
Practice Address - Street 1:4895 MONROE ST STE 203
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4349
Practice Address - Country:US
Practice Address - Phone:419-725-2527
Practice Address - Fax:419-725-2528
Is Sole Proprietor?:No
Enumeration Date:2008-05-04
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35093947207R00000X, 207RA0401X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00874900OtherMEDICARE RAILROAD
OH2964672Medicaid
OH3227246OtherUNITED HEALTH CARE
OH9096404OtherAETNA
OH000000676687OtherANTHEM
OH2964672Medicaid