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General NPI Number Information
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NPI Number | 1639237936
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC GROUP OF BIRMINGHAM,P.C.
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 04/07/2008
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Provider Practice Location Address
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Address Line | 1400 SOUTH 19TH STREET
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City | BIRMINGHAM
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State | AL
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Zip | 35205
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Country | US
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Telephone | 205-939-0610
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Fax | 205-930-9134
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Provider Business Mailing Address
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Address Line | 1400 SOUTH 19TH STREET
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City | BIRMINGHAM
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State | AL
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Zip | 35205
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Country | US
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Telephone | 205-939-0610
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Fax | 205-930-9134
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MARK ALAN ELKUS
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Credential | M.D.
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Telephone | 205-939-0610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XS0114X
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Taxonomy Name | Adult Reconstructive Orthopaedic Surgery Physician
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License Number | 00024049
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207XX0801X
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Taxonomy Name | Orthopaedic Trauma Physician
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License Number | 00024049
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 00024049
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License Number State | AL
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