Provider Demographics
NPI:1457523532
Name:ALI, AISHA (MD)
Entity Type:Individual
Prefix:
First Name:AISHA
Middle Name:
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 950244
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0244
Mailing Address - Country:US
Mailing Address - Phone:502-953-4700
Mailing Address - Fax:502-772-8189
Practice Address - Street 1:834 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40204-1072
Practice Address - Country:US
Practice Address - Phone:502-583-1981
Practice Address - Fax:502-583-1981
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44471208000000X
IN01070133A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100141320Medicaid
KYK189880Medicare PIN
KY50085652OtherPASSPORT
KY000000925153OtherANTHEM - NCMA
KY172402OtherSIHO