Healthcare Provider Details

I. General information

NPI: 1972780757
Provider Name (Legal Business Name): LEMAK SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

831 1ST ST N
ALABASTER AL
35007-8944
US

IV. Provider business mailing address

1286 OAK GROVE RD SUITE 200
BIRMINGHAM AL
35209-6929
US

V. Phone/Fax

Practice location:
  • Phone: 205-358-9120
  • Fax: 205-358-9121
Mailing address:
  • Phone: 205-329-7501
  • Fax: 205-329-7536

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. MATTHEW THOMAS LEMAK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 205-329-7501