Healthcare Provider Details

I. General information

NPI: 1134700131
Provider Name (Legal Business Name): SSD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MEDICAL PARK DR E STE 458
BIRMINGHAM AL
35235-3473
US

IV. Provider business mailing address

48 MEDICAL PARK DR E STE 458
BIRMINGHAM AL
35235-3473
US

V. Phone/Fax

Practice location:
  • Phone: 205-838-1811
  • Fax: 205-838-4525
Mailing address:
  • Phone: 205-838-1811
  • Fax: 205-838-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARIO KUMAR MARUTHUR
Title or Position: PHYSICIAN OWNER
Credential: MD
Phone: 205-900-2000