Provider Demographics
NPI:1184721128
Name:MADATHIKUNNEL, CYRIAC JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:CYRIAC
Middle Name:JOSEPH
Last Name:MADATHIKUNNEL
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 1:1013 MEDICAL CENTER PKWY
Mailing Address - Street 2:FRIST HOWELL BUILDING # 3
Mailing Address - City:SELMA
Mailing Address - State:AL
Mailing Address - Zip Code:36701-6742
Mailing Address - Country:US
Mailing Address - Phone:334-872-3339
Mailing Address - Fax:334-872-6200
Practice Address - Street 1:1013 MEDICAL CENTER PKWY
Practice Address - Street 2:FRIST HOWELL BUILDING # 3
Practice Address - City:SELMA
Practice Address - State:AL
Practice Address - Zip Code:36701-6742
Practice Address - Country:US
Practice Address - Phone:334-872-3339
Practice Address - Fax:334-872-6200
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00019370207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009915515Medicaid
ALG17003Medicare UPIN
AL009915515Medicaid