MEDICARE: BREERA KHURRAM

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	390200000X	Student in an Organized Health Care Education/Training Program		AL

General Provider Information

NPI Number	:	1558288829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREERA KHURRAM

Provider Business Mailing Address
First Line	:	292 BRIGHTFIELD DR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-6514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	625 19TH ST S
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35233-1900
Country	:	US
Telephone Number	:	334-747-7569
Fax Number	:	334-747-7590

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

Provider Enumeration Date	:	06/30/2026
Last Update Date	:	06/30/2026

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Directions to “ BREERA KHURRAM ” Practice Location

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