Healthcare Provider Details

I. General information

NPI: 1053367342
Provider Name (Legal Business Name): SUNIL K JAISWAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 03/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 MAIN STREET
COLLINSVILLE AL
35961
US

IV. Provider business mailing address

531 RIVER RIDGE RD
GADSDEN AL
35901-9303
US

V. Phone/Fax

Practice location:
  • Phone: 256-494-5744
  • Fax: 256-442-7594
Mailing address:
  • Phone: 256-442-7594
  • Fax: 256-442-7594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number22810
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: