Healthcare Provider Details

I. General information

NPI: 1629035118
Provider Name (Legal Business Name): AMY MARIE TAKACS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 SIVLEY SWRD 500
HUNTSVILLE AL
35801-5177
US

IV. Provider business mailing address

401 LOWELL DR SE STE 1
HUNTSVILLE AL
35801-3738
US

V. Phone/Fax

Practice location:
  • Phone: 256-265-3880
  • Fax: 256-265-3886
Mailing address:
  • Phone: 256-265-3880
  • Fax: 256-265-3886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number00027267
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: