Provider Demographics
| NPI: | 1649528134 |
|---|---|
| Name: | LLIVINA & HARRIGILL, M.D., P.C. |
| Entity type: | Organization |
| Organization Name: | LLIVINA & HARRIGILL, M.D., P.C. |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PHYSICIAN |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | KEITH |
| Authorized Official - Middle Name: | MARTIN |
| Authorized Official - Last Name: | HARRIGILL |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 205-838-1811 |
| Mailing Address - Street 1: | 48 MEDICAL PARK DR E |
| Mailing Address - Street 2: | SUITE 458 |
| Mailing Address - City: | BIRMINGHAM |
| Mailing Address - State: | AL |
| Mailing Address - Zip Code: | 35235-3400 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 205-838-1811 |
| Mailing Address - Fax: | 205-838-4252 |
| Practice Address - Street 1: | 48 MEDICAL PARK DR E |
| Practice Address - Street 2: | SUITE 458 |
| Practice Address - City: | BIRMINGHAM |
| Practice Address - State: | AL |
| Practice Address - Zip Code: | 35235-3400 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 205-838-1811 |
| Practice Address - Fax: | 205-838-4252 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-08-15 |
| Last Update Date: | 2012-08-15 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Single Specialty |