Healthcare Provider Details

I. General information

NPI: 1144604976
Provider Name (Legal Business Name): MISS TAL KOPPELMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 03/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

PO BOX 55310
BIRMINGHAM AL
35255-5310
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-4011
  • Fax:
Mailing address:
  • Phone: 205-731-9701
  • Fax: 205-297-9411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL.4314R
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberL.4314R
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: