Provider Demographics
NPI:1861778607
Name:ALI, AHMAD S (NP)
Entity type:Individual
Prefix:
First Name:AHMAD
Middle Name:S
Last Name:ALI
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7240 SHADELAND STATION
Practice Address - Street 2:SUITE 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3944
Practice Address - Country:US
Practice Address - Phone:317-621-6060
Practice Address - Fax:317-355-6965
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71003719A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM400058907OtherMEDICARE PIN TERMED
INP01189201OtherRR MEDICARE PTAN
IN201039100Medicaid
INM400058907OtherMEDICARE PIN TERMED