Provider Demographics
NPI:1184942765
Name:CHEEMA, ALI IMRAN (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:IMRAN
Last Name:CHEEMA
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 1:215 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2203
Mailing Address - Country:US
Mailing Address - Phone:859-655-6100
Mailing Address - Fax:859-655-6241
Practice Address - Street 1:101 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-2690
Practice Address - Country:US
Practice Address - Phone:859-881-4288
Practice Address - Fax:859-881-4388
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY49886207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100453020Medicaid