Provider Demographics
NPI:1437107984
Name:ELLERBUSCH, MICHAEL TODD (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:TODD
Last Name:ELLERBUSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 830791
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0791
Mailing Address - Country:US
Mailing Address - Phone:205-985-4111
Mailing Address - Fax:205-985-4326
Practice Address - Street 1:4517 SOUTHLAKE PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35244-3280
Practice Address - Country:US
Practice Address - Phone:205-985-4111
Practice Address - Fax:205-985-4326
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.210442081N0008X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009933849Medicaid
AL56685OtherBCBS OF ALABAMA