Basic Information
| Provider Information | |||||||||
| NPI: | 1144389586 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LLIVINA | ||||||||
| FirstName: | ELENA | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 STONEGATE TRL | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352422246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
| FaxNumber: | 2059779876 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 STONEGATE TRL | ||||||||
| Address2: | SUITE 112 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352422246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059779876 | ||||||||
| FaxNumber: | 2059779876 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 01/29/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 062913 | GA | N | Allopathic & Osteopathic Physicians | Dermatology | 207N00000X | 29784 | AL | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 510-66652 | 01 | AL | BCBS AL HSV | OTHER | 510-66644 | 01 | AL | BCBS AL BHAM | OTHER | 510-66647 | 01 | AL | BCBS AL MGM | OTHER |