Provider Demographics
NPI:1669536280
Name:DEVI P. MISRA M.D.,F.A.C.P
Entity type:Organization
Organization Name:DEVI P. MISRA M.D.,F.A.C.P
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVI
Authorized Official - Middle Name:P
Authorized Official - Last Name:MISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-880-0455
Mailing Address - Street 1:400 WHITESPORT DR SW
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6452
Mailing Address - Country:US
Mailing Address - Phone:256-880-0455
Mailing Address - Fax:
Practice Address - Street 1:400 WHITESPORT DR SW
Practice Address - Street 2:SUITE 103
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6452
Practice Address - Country:US
Practice Address - Phone:256-880-0455
Practice Address - Fax:256-882-6382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9102207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL411013507OtherMEDICARE RAILROAD
AL000004729Medicaid
AL051004729OtherBLUE CROSS BLUE SHIELD
AL510G700566Medicare PIN
AL051004729OtherBLUE CROSS BLUE SHIELD
AL000004729Medicare PIN