MEDICARE: DR. DANIEL MIRELMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	8570	AL
2	208C00000X	Colon & Rectal Surgery Physician	8570	AL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	406283026	OTHER	AL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1306805825	OTHER		NPI
4	510-01112	OTHER	AL	BLUE CROSS BLUE SHIELD
5	1922068774	OTHER		GROUP NPI NUMBER
6	63-0677675	OTHER		FEDERAL TAX ID

General Provider Information

NPI Number	:	1306805825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL MIRELMAN M.D.

Provider Business Mailing Address
First Line	:	2022 BROOKWOOD MEDICAL CTR DR
Second Line	:	SUITE 313 ACC
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6808
Country	:	US
Telephone Number	:	205-877-2910
Fax Number	:	205-879-4649

Provider Business Practice Location Address
First Line	:	2022 BROOKWOOD MEDICAL CTR DR
Second Line	:	SUITE 313 ACC
City	:	BIRMINGHAM
State	:	AL
Zip	:	35209-6808
Country	:	US
Telephone Number	:	205-877-2910
Fax Number	:	205-879-4649

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	10/23/2008

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