Healthcare Provider Details

I. General information

NPI: 1801473616
Provider Name (Legal Business Name): ADDISON MARK CIMINO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 01/02/2023
Certification Date: 06/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 13TH ST S
BIRMINGHAM AL
35205-5327
US

IV. Provider business mailing address

1313 13TH ST S
BIRMINGHAM AL
35205-5327
US

V. Phone/Fax

Practice location:
  • Phone: 256-694-0448
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number000000000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: