Healthcare Provider Details

I. General information

NPI: 1366515033
Provider Name (Legal Business Name): MARK ALAN ELKUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 12/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SOUTH 19TH STREET
BIRMINGHAM AL
35213
US

IV. Provider business mailing address

1400 SOUTH 19TH STREET
BIRMINGHAM AL
35213
US

V. Phone/Fax

Practice location:
  • Phone: 205-939-0610
  • Fax: 205-930-9134
Mailing address:
  • Phone: 205-939-0610
  • Fax: 205-930-9134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number00024049
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number00024049
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number00024049
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number24049
License Number StateAL
# 5
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number24049
License Number StateAL
# 6
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number24049
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: