Provider Demographics
NPI:1750581401
Name:PLATONOV, MICHAEL ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALEXANDER
Last Name:PLATONOV
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 1:1530 3RD AVE SOUTH
Mailing Address - Street 2:321-5 TINSLEY HARRISON TOWER U OF AL DIV OF CARDIOVASC
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0006
Mailing Address - Country:US
Mailing Address - Phone:205-934-1335
Mailing Address - Fax:205-934-1279
Practice Address - Street 1:619 19TH ST SOUTH
Practice Address - Street 2:U OF AL BIRMINGHAM HOSPITAL U OF AL BIRMINGHAM HTH SYS
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35249
Practice Address - Country:US
Practice Address - Phone:205-934-0411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALL2865R390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program