MEDICARE: MR. MICHAEL JEROME STURDIVANT

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number State
1	101YP2500X	Professional Counselor	AL
2	101YM0800X	Mental Health Counselor	AL
3	103TP2701X	Group Psychotherapy Psychologist	AL
4	106H00000X	Marriage & Family Therapist	AL
5	133N00000X	Nutritionist	AL
6	133VN1201X	Obesity and Weight Management Nutrition Registered Dietitian	AL
7	171400000X	Health & Wellness Coach	AL
8	173C00000X	Reflexologist	AL
9	174200000X	Meals Provider	AL
10	174H00000X	Health Educator	AL
11	175L00000X	Homeopath	AL
12	225700000X	Massage Therapist	AL
13	261QI0500X	Infusion Therapy Clinic/Center	AL
14	320800000X	Mental Illness Community Based Residential Treatment Facility	AL
15	175F00000X	Naturopath	AL

General Provider Information

NPI Number	:	1730050014
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL JEROME STURDIVANT

Provider Business Mailing Address
First Line	:	4100 MARKET ST STE 100
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35808-3007
Country	:	US
Telephone Number	:	256-203-3883
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 BOB WALLACE AVE SW STE 205
Second Line	:
City	:	HUNTSVILLE
State	:	AL
Zip	:	35805-4064
Country	:	US
Telephone Number	:	256-690-3943
Fax Number	:

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

Provider Enumeration Date	:	09/17/2025
Last Update Date	:	10/24/2025

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