Provider Demographics
NPI:1295779478
Name:FIX, KATHLEEN
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:FIX
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35233-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1717 6TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-1801
Practice Address - Country:US
Practice Address - Phone:800-822-8816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL13619207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12980OtherHEALTHSPRING OF ALABAMA
AL009932089Medicaid
AL009910956Medicaid
ALA51967OtherVIVA
AL000017591OtherBLUE CROSS
AL000046376Medicaid
AL000080990Medicaid
AL051109315OtherBLUE CROSS
AL110019794OtherRAILROAD MEDICARE
AL122209Medicaid
AL000017591Medicaid
AL051502288OtherBLUE CROSS
AL051502288Medicaid
AL051541960OtherBLUE CROSS
AL110019794Medicare PIN
AL051109315OtherBLUE CROSS
AL000046376Medicare ID - Type Unspecified
ALA51967OtherVIVA