Healthcare Provider Details

I. General information

NPI: 1629504873
Provider Name (Legal Business Name): TUSHAR MISHRA M.D./MBBS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 PRINCETON AVE SW STE 707
BIRMINGHAM AL
35211-1395
US

IV. Provider business mailing address

801 PRINCETON AVE SW STE 707
BIRMINGHAM AL
35211-1395
US

V. Phone/Fax

Practice location:
  • Phone: 205-780-4330
  • Fax: 205-780-7775
Mailing address:
  • Phone: 205-780-4330
  • Fax: 205-780-7775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD.51021
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number51021
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number51021
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: