Provider Demographics
NPI:1700890233
Name:KULBACK, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:KULBACK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK EAST DRIVE
Mailing Address - Street 2:SUITE 356
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235
Mailing Address - Country:US
Mailing Address - Phone:205-838-3200
Mailing Address - Fax:205-838-6981
Practice Address - Street 1:48 MEDICAL PARK EAST DRIVE
Practice Address - Street 2:SUITE 356
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235
Practice Address - Country:US
Practice Address - Phone:205-838-3200
Practice Address - Fax:205-838-6981
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL00009116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51512225OtherBCBS
AL529913030Medicaid
110245852OtherRR MCR
AL529913030Medicaid
051512225Medicare PIN