MEDICARE: UNIV. OF ALABAMA BIRMINGHAM HOSPITAL

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	282N00000X	General Acute Care Hospital	L3716F	AL

General Provider Information

NPI Number	:	1528311271
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIV. OF ALABAMA BIRMINGHAM HOSPITAL

Provider Business Mailing Address
First Line	:	510 20TH STREET, SOUTH (FOT-1164)
Second Line	:	UAB, PLASTIC SURGERY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-3411
Country	:	US
Telephone Number	:	205-934-3245
Fax Number	:	205-975-6155

Provider Business Practice Location Address
First Line	:	510 20TH ST. SO (FOT-1164)
Second Line	:	UAB, PLASTIC SURGERY
City	:	BIRMINGHAM
State	:	AL
Zip	:	35294-3411
Country	:	US
Telephone Number	:	205-934-3245
Fax Number	:	205-975-6155

Authorized Official
Title or Position	:	PLASTIC SURGEON
Name	:	DR. KAMIL MARCIN PIETRASIK
Credential	:	MD, PHD
Telephone Number	:	205-934-3245

Provider Enumeration Date	:	10/18/2012
Last Update Date	:	10/18/2012

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