Provider Demographics
NPI:1801829833
Name:SIMON MIRELMAN UROLOGY, PC
Entity Type:Organization
Organization Name:SIMON MIRELMAN UROLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMON
Authorized Official - Middle Name:WEISS
Authorized Official - Last Name:MIRELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-874-8300
Mailing Address - Street 1:2204 LAKESHORE DRIVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209
Mailing Address - Country:US
Mailing Address - Phone:205-874-8300
Mailing Address - Fax:205-874-8333
Practice Address - Street 1:513 BROAKWOOD BLVD
Practice Address - Street 2:SUITE 500
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209
Practice Address - Country:US
Practice Address - Phone:205-877-2767
Practice Address - Fax:205-877-2914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000051776Medicaid
AL009910394Medicaid
AL529932870Medicaid