Provider Demographics
NPI:1437351905
Name:LUELLEN, TODD DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DOUGLAS
Last Name:LUELLEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3263 DEMETROPOLIS RD
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36693-4638
Mailing Address - Country:US
Mailing Address - Phone:251-602-5850
Mailing Address - Fax:251-602-5855
Practice Address - Street 1:3263 DEMETROPOLIS RD
Practice Address - Street 2:SUITE 11
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-4638
Practice Address - Country:US
Practice Address - Phone:251-602-5850
Practice Address - Fax:251-602-5855
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL199062084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALF66993Medicare UPIN