Provider Demographics
NPI:1487628111
Name:BIRK, RAINER A (MD)
Entity Type:Individual
Prefix:DR
First Name:RAINER
Middle Name:A
Last Name:BIRK
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:PO BOX 1547
Mailing Address - Street 2:300 MEDICAL AVE STE 1
Mailing Address - City:ANDALUSIA
Mailing Address - State:AL
Mailing Address - Zip Code:36420
Mailing Address - Country:US
Mailing Address - Phone:334-222-8734
Mailing Address - Fax:334-222-8736
Practice Address - Street 1:300 MEDICAL AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ANDALUSIA
Practice Address - State:AL
Practice Address - Zip Code:36420
Practice Address - Country:US
Practice Address - Phone:334-222-8734
Practice Address - Fax:334-222-8736
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE2547207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR141469001Medicaid
AR141469001Medicaid
AR5L532Medicare ID - Type Unspecified