Healthcare Provider Details

I. General information

NPI: 1417007808
Provider Name (Legal Business Name): GENA COLLEEN DUNIVAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GENA COLLEEN MCILWAIN-DUNIVAN M.D.

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/29/2023
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 6TH AVE S
BIRMINGHAM AL
35233-1802
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-996-3130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberMD2010-0175
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number2007-00553
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberMD2010-0175
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number43934
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: