Healthcare Provider Details

I. General information

NPI: 1255444089
Provider Name (Legal Business Name): MICHAEL A REMILLARD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

270 VILLAGE PKWY
HELENA AL
35080-4040
US

IV. Provider business mailing address

200 BEACON PKWY W SUITE 330
BIRMINGHAM AL
35209-3102
US

V. Phone/Fax

Practice location:
  • Phone: 205-664-9430
  • Fax: 205-664-1846
Mailing address:
  • Phone: 205-715-5910
  • Fax: 205-715-5928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21972
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: