Individual
MR. ALI GHASEMZADEH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5062 STATE ROUTE 125, GEORGETOWN, OH 45121-9561
(937) 378-9090
(937) 378-0102
Mailing address
PO BOX 577, GEORGETOWN, OH 45121
(937) 378-9090
(937) 378-0102
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35080480
OH
207RC0000X
Cardiovascular Disease Physician
38551
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0904701
MEDICAID
KY
05
—
2291738
—
OH
01
—
64073497
MEDICAID
KY
Enumeration date
08/30/2006
Last updated
11/15/2011
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