Provider Demographics
NPI:1972578813
Name:HILL-ALI, MARLYCE R (MD)
Entity Type:Individual
Prefix:
First Name:MARLYCE
Middle Name:R
Last Name:HILL-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 1:2406 W BROADWAY
Mailing Address - Street 2:STE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40211-1008
Mailing Address - Country:US
Mailing Address - Phone:502-775-1211
Mailing Address - Fax:502-775-1221
Practice Address - Street 1:2406 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40211-1008
Practice Address - Country:US
Practice Address - Phone:502-775-1211
Practice Address - Fax:502-775-1221
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY39221207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100023870Medicaid
KYH98591Medicare UPIN
KYP00179728Medicare PIN
KY0609077Medicare Oscar/Certification