Healthcare Provider Details

I. General information

NPI: 1427595511
Provider Name (Legal Business Name): LEMAK SPORTS MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 01/26/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2215 DECATUR HWY STE 117
GARDENDALE AL
35071-2384
US

IV. Provider business mailing address

1286 OAK GROVE RD SUITE 100
BIRMINGHAM AL
35209-6929
US

V. Phone/Fax

Practice location:
  • Phone: 205-631-3828
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW LEMAK
Title or Position: CEO
Credential:
Phone: 205-329-7501