Provider Demographics
NPI:1881622488
Name:KAMAL. K. RAISANI, M.D. P.C.
Entity type:Organization
Organization Name:KAMAL. K. RAISANI, M.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR. PSYCHAITRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:K
Authorized Official - Last Name:RAISANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-556-0014
Mailing Address - Street 1:507 ENERGY CENTER BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35473
Mailing Address - Country:US
Mailing Address - Phone:205-556-7717
Mailing Address - Fax:205-556-7717
Practice Address - Street 1:507 ENERGY CENTER BLVD
Practice Address - Street 2:STE 305
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473
Practice Address - Country:US
Practice Address - Phone:205-556-7717
Practice Address - Fax:205-556-7717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL214612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALG66282Medicare UPIN