Provider Demographics
NPI:1356323547
Name:BECKENSTEIN, MICHAEL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:BECKENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 SAINT VINCENTS DR
Mailing Address - Street 2:SUITE 610
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1620
Mailing Address - Country:US
Mailing Address - Phone:205-933-9308
Mailing Address - Fax:205-939-3353
Practice Address - Street 1:800 SAINT VINCENTS DR
Practice Address - Street 2:SUITE 610
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-1620
Practice Address - Country:US
Practice Address - Phone:205-933-9308
Practice Address - Fax:205-939-3353
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021270174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL94656OtherBLUECROSS PROVIDER NUMBER
ALF99861Medicare UPIN