Provider Demographics
NPI:1538156369
Name:ARTAR, ALI O (MD)
Entity type:Individual
Prefix:
First Name:ALI
Middle Name:O
Last Name:ARTAR
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 1:7330 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53220-3849
Mailing Address - Country:US
Mailing Address - Phone:414-817-8896
Mailing Address - Fax:414-817-8940
Practice Address - Street 1:7330 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-3849
Practice Address - Country:US
Practice Address - Phone:414-817-8896
Practice Address - Fax:414-817-8940
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01064085A2084S0012X
WI67996-202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000533634OtherANTHEM BXBS
WI1538156369Medicaid
IN200869370Medicaid
716700FFMedicare PIN