Healthcare Provider Details

I. General information

NPI: 1861569923
Provider Name (Legal Business Name): COTTAGE HILL PODIATRY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 MONTLIMAR DR
MOBILE AL
36609-1645
US

IV. Provider business mailing address

1371 MONTLIMAR DR
MOBILE AL
36609-1645
US

V. Phone/Fax

Practice location:
  • Phone: 251-304-0804
  • Fax: 251-304-0806
Mailing address:
  • Phone: 251-304-0804
  • Fax: 251-304-0806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0064
License Number StateAL

VIII. Authorized Official

Name: DR. ELLIOT JAY BRAUN
Title or Position: PRESIDENT
Credential: DPM
Phone: 251-304-0804