Provider Demographics
NPI:1902845829
Name:GOYAL, MUNISH KUMAR (MD)
Entity Type:Individual
Prefix:
First Name:MUNISH
Middle Name:KUMAR
Last Name:GOYAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 LAY DAM RD
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-8344
Mailing Address - Country:US
Mailing Address - Phone:205-663-5775
Mailing Address - Fax:205-739-2049
Practice Address - Street 1:2700 10TH AVE SOUTH
Practice Address - Street 2:BUILDING 2 STE 305
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205
Practice Address - Country:US
Practice Address - Phone:205-939-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23641207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL05135158Medicaid
ALI55570Medicare UPIN
AL05135158Medicaid