MEDICARE: ELMAR M LAWACZECK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	00003714	AL

General Provider Information

NPI Number	:	1053310094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELMAR M LAWACZECK M.D.

Provider Business Mailing Address
First Line	:	1009 MONTGOMERY HWY
Second Line	:	SUITE 200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-2805
Country	:	US
Telephone Number	:	205-397-9400
Fax Number	:	205-397-9455

Provider Business Practice Location Address
First Line	:	1009 MONTGOMERY HWY
Second Line	:	SUITE 200
City	:	BIRMINGHAM
State	:	AL
Zip	:	35216-2805
Country	:	US
Telephone Number	:	205-397-9400
Fax Number	:	205-397-9455

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	07/11/2007

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