Provider Demographics
NPI:1528011079
Name:GRINDER, KELLI FOLGMAN (MD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:FOLGMAN
Last Name:GRINDER
Suffix:
Gender:F
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 830230
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0230
Mailing Address - Country:US
Mailing Address - Phone:205-250-6006
Mailing Address - Fax:205-250-8139
Practice Address - Street 1:1604 STOUTS RD
Practice Address - Street 2:
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068-1962
Practice Address - Country:US
Practice Address - Phone:205-849-9811
Practice Address - Fax:205-849-9812
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL25673207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554518Medicaid
ALH99329Medicare UPIN
AL051554518Medicaid