Provider Demographics
NPI:1922088657
Name:AYALA, KALIPRASAD N (MD)
Entity Type:Individual
Prefix:
First Name:KALIPRASAD
Middle Name:N
Last Name:AYALA
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 1:7440 S 91ST ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9797
Mailing Address - Country:US
Mailing Address - Phone:402-489-6555
Mailing Address - Fax:402-328-3770
Practice Address - Street 1:7440 S 91ST ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9797
Practice Address - Country:US
Practice Address - Phone:402-489-6555
Practice Address - Fax:402-328-3770
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-24412207RC0000X
NE18871207RC0000X
IA04-24412207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10026072500Medicaid
NE10026072000Medicaid
NE10026072300Medicaid
NE47070592301Medicaid
NE47070592306Medicaid
IA0537050Medicaid
NE10026072400Medicaid
NE10026072200Medicaid
NE10026072600Medicaid
NE47070592305Medicaid
NE47070592313Medicaid
KS100156660BMedicaid
NE47070592300Medicaid
NE47070592302Medicaid
NE47070592302Medicaid
NE10026072400Medicaid
NE268239Medicare PIN
NE060019358Medicare PIN
NE47070592300Medicaid
IAIB2244006Medicare PIN
NE10026072200Medicaid
NENA1080010Medicare PIN
F36850Medicare UPIN
KSKA2283008Medicare PIN