Provider Demographics
NPI:1639112329
Name:CONKLIN, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CONKLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1600 7TH AVE S
Mailing Address - Street 2:LOWDER 316
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1711
Mailing Address - Country:US
Mailing Address - Phone:205-638-9146
Mailing Address - Fax:205-638-9833
Practice Address - Street 1:1600 7TH AVE S
Practice Address - Street 2:LOWDER 316
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1711
Practice Address - Country:US
Practice Address - Phone:205-638-9146
Practice Address - Fax:205-638-9833
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL17564207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000085351Medicaid
AL009996775Medicaid
MS0123411OtherMISSISSIPPI MEDICAID
ALF64351OtherVIVA
AL000085351OtherBLUE CROSS
AL110723997AOtherGEORGIA MEDICAID
AL009932087Medicaid
AL051528498OtherBLUE CROSS
ALF64351OtherHEALTHSPRING
AL051529348OtherBLUE CROSS
AL110723997AOtherGEORGIA MEDICAID