Mariam Issac Ali
Individual provider Active NPI Taxi · Burlington, KY
NPI 1164088282 · NPPES record last updated May 14, 2019
Key facts
- NPI
- 1164088282
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Taxi 344600000X
- License
- 4720 (KY)
- Practice address
- 6064 Southpointe Dr
Burlington, KY 41005-8528 - Phone
- (619) 822-5621
- NPI assigned
- May 14, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4720 | KY | MD | Taxi |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Taxi | 344600000X | 4720 | KY | Yes |
Addresses
Primary practice location
6064 Southpointe Dr
Burlington, KY 41005-8528
Mailing address
6064 Southpointe Dr
Burlington, KY 41005-8528
Phone (619) 822-5621
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7100592580 | Medicaid | KY |
Other providers in Burlington, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 14, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.