Provider Demographics
NPI:1952454746
Name:SUMMIT INTERNAL MEDICINE
Entity Type:Organization
Organization Name:SUMMIT INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:WYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-595-9222
Mailing Address - Street 1:3570 GRANDVIEW PARKWAY
Mailing Address - Street 2:SUITE 100-A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35243-2033
Mailing Address - Country:US
Mailing Address - Phone:205-595-9222
Mailing Address - Fax:205-595-9444
Practice Address - Street 1:3570 GRANDVIEW PARKWAY SUITE 100-A
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35243-2033
Practice Address - Country:US
Practice Address - Phone:205-595-9222
Practice Address - Fax:205-595-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00021252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
051525419Medicare ID - Type Unspecified
AL051516577Medicare ID - Type Unspecified
ALH12516Medicare UPIN
ALH61233Medicare UPIN