Provider Demographics
NPI:1144227026
Name:ISMAIL, ASAD E (MD)
Entity type:Individual
Prefix:
First Name:ASAD
Middle Name:E
Last Name:ISMAIL
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 1:720 W BROADWAY STE 202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3245
Mailing Address - Country:US
Mailing Address - Phone:502-561-0943
Mailing Address - Fax:502-561-0944
Practice Address - Street 1:645 S ROY WILKINS AVE STE 200
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-2072
Practice Address - Country:US
Practice Address - Phone:502-561-0520
Practice Address - Fax:502-653-8181
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY341742084P0800X
IN01050254A2084P0800X, 2084A0401X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100386460OtherMEDICAID GROUP
IN200244600AMedicaid
214446000OtherMAGELLAN MIS
KY130025311OtherMEDICARE RAILROAD
000000056294OtherANTHEM GROUP
IN160860OtherMEDICARE GROUP
KY65927857Medicaid
KY82900176Medicaid
KYCK2274OtherRAILROAD MEDICARE GROUP
KY64342744Medicaid
000000328529OtherANTHEM
INCG3623OtherRAILROAD MEDICARE GROUP
KY2444451000OtherPASSPORT GROUP
KY78903689Medicaid
IN160780OtherMEDICARE GROUP
KY2699709000OtherPASSPORT ADVANTAGE
50704000OtherMAGELLAN MIS
KY6764OtherMEDICARE GROUP
INP00127309OtherMEDICARE RAILROAD
1063415297OtherGROUP NPI
INP00127309OtherMEDICARE RAILROAD
KY64342744Medicaid
KY82900176Medicaid