Provider Demographics
NPI:1528558368
Name:MIESCH, CRISTINA B (MD)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:B
Last Name:MIESCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:B
Other - Last Name:LEIVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2316 7TH AVE S STE 100
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-3215
Mailing Address - Country:US
Mailing Address - Phone:205-251-4141
Mailing Address - Fax:205-251-2004
Practice Address - Street 1:2316 7TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-3215
Practice Address - Country:US
Practice Address - Phone:205-251-4141
Practice Address - Fax:205-251-2004
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA276142390200000X
AL42965208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL273391Medicaid