Provider Demographics
NPI:1144389586
Name:LLIVINA, ELENA M (MD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:M
Last Name:LLIVINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 STONEGATE TRL
Mailing Address - Street 2:SUITE 112
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-2246
Mailing Address - Country:US
Mailing Address - Phone:205-977-9876
Mailing Address - Fax:205-977-9876
Practice Address - Street 1:2000 STONEGATE TRL
Practice Address - Street 2:SUITE 112
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2246
Practice Address - Country:US
Practice Address - Phone:205-977-9876
Practice Address - Fax:205-977-9876
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA062913207N00000X
AL29784207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-66652OtherBCBS AL HSV
AL510-66644OtherBCBS AL BHAM
AL510-66647OtherBCBS AL MGM
AL510-66644OtherBCBS AL BHAM