Healthcare Provider Details

I. General information

NPI: 1437107984
Provider Name (Legal Business Name): MICHAEL TODD ELLERBUSCH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4517 SOUTHLAKE PKWY SUITE 202
BIRMINGHAM AL
35244-3280
US

IV. Provider business mailing address

PO BOX 830791
BIRMINGHAM AL
35283-0791
US

V. Phone/Fax

Practice location:
  • Phone: 205-985-4111
  • Fax: 205-985-4326
Mailing address:
  • Phone: 205-985-4111
  • Fax: 205-985-4326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberMD.21044
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2081N0008X
TaxonomyNeuromuscular Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD.21044
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: