Provider Demographics
NPI:1942282173
Name:KULBACK, PAMELA (MD)
Entity Type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:
Last Name:KULBACK
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 1:7500 HUGH DANIEL DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-991-1830
Mailing Address - Fax:205-991-1865
Practice Address - Street 1:7500 HUGH DANIEL DR
Practice Address - Street 2:SUITE 150
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-991-1830
Practice Address - Fax:205-991-1865
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD137422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51001318OtherBC SHELBY
AL009932439Medicaid
AL009933068Medicaid
AL009932437Medicaid
AL009932438Medicaid
AL009932441Medicaid
AL51001316OtherBC GREYSTONE
AL51001317OtherBC MONTCLAIR
AL51001321OtherBC 280
AL51001322OtherBC SYLACAUGA
AL009932438Medicaid
AL009932437Medicaid
C79053Medicare UPIN
AL51001318OtherBC SHELBY