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General NPI Number Information
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NPI Number | 1881622488
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Entity Type | Organization
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Legal Business Name | KAMAL. K. RAISANI, M.D. P.C.
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Dates
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Enumeration Date | 06/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 507 ENERGY CENTER BLVD STE 305
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City | NORTHPORT
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State | AL
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Zip | 35473
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Country | US
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Telephone | 205-556-7717
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Fax | 205-556-7717
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Provider Business Mailing Address
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Address Line | 507 ENERGY CENTER BLVD STE 305
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City | NORTHPORT
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State | AL
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Zip | 35473
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Country | US
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Telephone | 205-556-7717
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Fax | 205-556-7717
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Authorized Official
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Title or Position | DR. PSYCHAITRIST
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Name | DR. KAMAL K RAISANI
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Credential | M.D.
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Telephone | 205-556-0014
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21461
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License Number State | AL
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