Healthcare Provider Details

I. General information

NPI: 1023111820
Provider Name (Legal Business Name): KEVIN C. STAUDINGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

833 PRINCETON AVE SW POB II; SUITE 150
BIRMINGHAM AL
35211-1323
US

IV. Provider business mailing address

200 BEACON PKWY W SUITE 330
BIRMINGHAM AL
35209-3102
US

V. Phone/Fax

Practice location:
  • Phone: 205-781-2699
  • Fax: 205-781-2690
Mailing address:
  • Phone: 205-715-5910
  • Fax: 205-715-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number18848
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: