Healthcare Provider Details

I. General information

NPI: 1174785562
Provider Name (Legal Business Name): VIPLOVE SENADHI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2008
Last Update Date: 09/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 PINE ST SUITE 801
MONTGOMERY AL
36106-1103
US

IV. Provider business mailing address

PO BOX 242848
MONTGOMERY AL
36124-2848
US

V. Phone/Fax

Practice location:
  • Phone: 334-239-7059
  • Fax: 334-239-7841
Mailing address:
  • Phone: 334-239-7059
  • Fax: 334-239-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberDO.1453
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: