Provider Demographics
NPI:1396844197
Name:PASSARELLA, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:PASSARELLA
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 1:1 INDEPENDENCE PLAZA
Mailing Address - Street 2:SUITE 900
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-2643
Mailing Address - Country:US
Mailing Address - Phone:205-271-8000
Mailing Address - Fax:205-271-8050
Practice Address - Street 1:1 INDEPENDENCE PLAZA
Practice Address - Street 2:SUITE 900
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-2643
Practice Address - Country:US
Practice Address - Phone:205-271-8000
Practice Address - Fax:205-271-8050
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26409207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL121773Medicaid
AL121774Medicaid
AL051108906OtherBCBS
MS08820089Medicaid
AL051108908OtherBCBS
AL121772Medicaid
AL051558055Medicaid
AL051004346OtherBLUE CROSS BLUE SHIELD AL
AL051108907OtherBCBS
ALP00386635OtherRAILRAOD MEDICARE
ALP00386635OtherRAILRAOD MEDICARE
ALI62832Medicare PIN
AL051004346OtherBLUE CROSS BLUE SHIELD AL