Basic Information
| Provider Information | |||||||||
| NPI: | 1568531820 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGHLANDS INTERNAL MEDICINE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2422 DANVILLE RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563502211 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2422 DANVILLE RD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | DECATUR | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563502211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2006 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SELJUKI | ||||||||
| AuthorizedOfficialFirstName: | ADNAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2563502211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 21615 | AL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 51537676 | 01 | AL | BCBS | OTHER |