Healthcare Provider Details

I. General information

NPI: 1932843125
Provider Name (Legal Business Name): RAVI HIREMAGALORE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2022
Last Update Date: 04/24/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 20TH ST S STE 858
BIRMINGHAM AL
35233-2028
US

IV. Provider business mailing address

510 20TH ST S STE 858
BIRMINGHAM AL
35233-2028
US

V. Phone/Fax

Practice location:
  • Phone: 205-975-1017
  • Fax:
Mailing address:
  • Phone: 205-975-1017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberL.5617SP
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: