Healthcare Provider Details

I. General information

NPI: 1558288829
Provider Name (Legal Business Name): BREERA KHURRAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 19TH ST S
BIRMINGHAM AL
35233-1900
US

IV. Provider business mailing address

292 BRIGHTFIELD DR
BALLWIN MO
63021-6514
US

V. Phone/Fax

Practice location:
  • Phone: 334-747-7569
  • Fax: 334-747-7590
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: