Provider Demographics
NPI:1720070659
Name:AMIN, VIPUL THAKORBHAI (MD)
Entity Type:Individual
Prefix:
First Name:VIPUL
Middle Name:THAKORBHAI
Last Name:AMIN
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 1:1026 GOODYEAR AVE BLDG 400
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1102
Mailing Address - Country:US
Mailing Address - Phone:256-467-4477
Mailing Address - Fax:256-467-4830
Practice Address - Street 1:1026 GOODYEAR AVE BLDG 400
Practice Address - Street 2:SUITE 201
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-467-4477
Practice Address - Fax:256-467-4830
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL23716207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009940010Medicaid
AL100014620OtherRAILROAD MEDICARE
AL051523153Medicare PIN
ALG48153Medicare UPIN
AL000098965Medicare ID - Type Unspecified