Healthcare Provider Details

I. General information

NPI: 1023578127
Provider Name (Legal Business Name): SEVAN KOMSHIAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2019
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVENUE SOUTH LOWDER 420
BIRMINGHAM AL
35233
US

IV. Provider business mailing address

1600 7TH AVENUE SOUTH LOWDER 420
BIRMINGHAM AL
35233
US

V. Phone/Fax

Practice location:
  • Phone: 800-879-2467
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number48894
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: