MEDICARE: IRENA BUKELIS 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	2084P0800X	Psychiatry Physician	MD.33159	AL
2	2084P0804X	Child & Adolescent Psychiatry Physician	33159	AL
3	2084P0804X	Child & Adolescent Psychiatry Physician	MD.33159	AL

General Provider Information

NPI Number	:	1659699577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENA BUKELIS M.D.

Provider Business Mailing Address
First Line	:	400 VESTAVIA PKWY STE 102
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3784
Country	:	US
Telephone Number	:	205-352-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VESTAVIA PKWY
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-3763
Country	:	US
Telephone Number	:	205-352-2000
Fax Number	:

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

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	06/29/2023

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