Healthcare Provider Details

I. General information

NPI: 1144227026
Provider Name (Legal Business Name): ASAD E ISMAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 S ROY WILKINS AVE STE 200
LOUISVILLE KY
40203-2072
US

IV. Provider business mailing address

720 W BROADWAY STE 202
LOUISVILLE KY
40202-3245
US

V. Phone/Fax

Practice location:
  • Phone: 502-561-0520
  • Fax: 502-653-8181
Mailing address:
  • Phone: 502-561-0943
  • Fax: 502-561-0944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34174
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01050254A
License Number StateIN
# 3
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number01050254A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: