Healthcare Provider Details

I. General information

NPI: 1659699577
Provider Name (Legal Business Name): IRENA BUKELIS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 06/29/2023
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 VESTAVIA PKWY
VESTAVIA AL
35216-3763
US

IV. Provider business mailing address

400 VESTAVIA PKWY STE 102
VESTAVIA AL
35216-3784
US

V. Phone/Fax

Practice location:
  • Phone: 205-352-2000
  • Fax:
Mailing address:
  • Phone: 205-352-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD.33159
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number33159
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberMD.33159
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: