Provider Demographics
NPI:1053422642
Name:AJMANI, DEEP (MD)
Entity type:Individual
Prefix:
First Name:DEEP
Middle Name:
Last Name:AJMANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:200 E CHESTNUT ST
Practice Address - Street 2:SERVICES BLDG, STE 303
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1831
Practice Address - Country:US
Practice Address - Phone:502-629-5552
Practice Address - Fax:502-629-3132
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36867207R00000X, 208M00000X
IN01054037A208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64051717Medicaid
KY3933147OtherCIGNA - NICS
KY053263OtherSIHO - NICS
IN200539510Medicaid
KY50025232OtherPASSPORT - NICS
KY000000623994OtherANTHEM - NICS
KY3731183000OtherPASSPORT ADVANTAGE - NICS
KY000023036COtherHUMANA - NICS
IN200539510Medicaid
KY000000623994OtherANTHEM - NICS
KY053263OtherSIHO - NICS
KY64051717Medicaid