Provider Demographics
NPI:1326130550
Name:INTERNAL MEDICINE AND PEDIATRICS OF CULLMAN
Entity Type:Organization
Organization Name:INTERNAL MEDICINE AND PEDIATRICS OF CULLMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LUNSFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-739-1575
Mailing Address - Street 1:1948 AL HIGHWAY 157
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0642
Mailing Address - Country:US
Mailing Address - Phone:256-739-1575
Mailing Address - Fax:256-255-1492
Practice Address - Street 1:1948 AL HIGHWAY 157
Practice Address - Street 2:SUITE 360
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0642
Practice Address - Country:US
Practice Address - Phone:256-739-1575
Practice Address - Fax:256-255-1492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL22073174400000X
AL24413174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty