Provider Demographics
NPI:1760471973
Name:DESIMONE, MURIEL ALINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MURIEL
Middle Name:ALINE
Last Name:DESIMONE
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 1:115 MANNING DRIVE
Mailing Address - Street 2:SUITE A-101
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801
Mailing Address - Country:US
Mailing Address - Phone:256-533-1030
Mailing Address - Fax:256-533-1043
Practice Address - Street 1:115 MANNING DRIVE
Practice Address - Street 2:SUITE A-101
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-1030
Practice Address - Fax:256-533-1043
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV9453208000000X
AL33937208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVDM277ZMedicare PIN
NVDM277YMedicare PIN
NV1760471973Medicaid