Healthcare Provider Details

I. General information

NPI: 1295437911
Provider Name (Legal Business Name): ALI BHUTTO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 S JACKSON ST
LOUISVILLE KY
40202-1622
US

IV. Provider business mailing address

10400 THRIFT DR APT 109
LOUISVILLE KY
40223-0114
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5242
  • Fax:
Mailing address:
  • Phone: 469-407-1344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number06376
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: