Healthcare Provider Details

I. General information

NPI: 1720070659
Provider Name (Legal Business Name): VIPUL THAKORBHAI AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 01/12/2023
Certification Date: 01/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1026 GOODYEAR AVE BLDG 400 SUITE 201
GADSDEN AL
35903-1102
US

IV. Provider business mailing address

1026 GOODYEAR AVE BLDG 400 SUITE 201
GADSDEN AL
35903-1102
US

V. Phone/Fax

Practice location:
  • Phone: 256-467-4477
  • Fax: 256-467-4830
Mailing address:
  • Phone: 256-467-4477
  • Fax: 256-467-4830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number23716
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: