Healthcare Provider Details

I. General information

NPI: 1699415919
Provider Name (Legal Business Name): KHALID WALEED AL-ALI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2022
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 KINGSWAY DR STE 105A
INDIANAPOLIS IN
46205-1549
US

IV. Provider business mailing address

240 N TILLOTSON AVE
MUNCIE IN
47304-3988
US

V. Phone/Fax

Practice location:
  • Phone: 317-803-2270
  • Fax: 317-217-1769
Mailing address:
  • Phone: 765-288-1928
  • Fax: 765-741-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01097498A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: