Provider Demographics
NPI:1871662684
Name:ALI, RIZWAN (MD)
Entity Type:Individual
Prefix:
First Name:RIZWAN
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 689022
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37068-9022
Mailing Address - Country:US
Mailing Address - Phone:615-778-8539
Mailing Address - Fax:
Practice Address - Street 1:124 E OFFICE ST
Practice Address - Street 2:
Practice Address - City:HARRODSBURG
Practice Address - State:KY
Practice Address - Zip Code:40330-1606
Practice Address - Country:US
Practice Address - Phone:859-253-1686
Practice Address - Fax:859-254-2743
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY327992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY0331217Medicare ID - Type UnspecifiedMEDICARE
KY0406209Medicare ID - Type UnspecifiedMEDICARE
KY0575125Medicare ID - Type UnspecifiedMEDICARE
KY30615058Medicaid
KY0331315Medicare ID - Type UnspecifiedMEDICARE
KY0045371Medicare ID - Type UnspecifiedMEDICARE
KYG51553Medicare UPIN
KY0331922Medicare ID - Type UnspecifiedMEDICARE
KY260045908Medicare ID - Type UnspecifiedMEDICARE
KY0331713Medicare ID - Type UnspecifiedMEDICARE
KY3319Medicare ID - Type UnspecifiedMEDICARE