Basic Information
| Provider Information | |||||||||
| NPI: | 1588753370 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KODALI | ||||||||
| FirstName: | VIJAY | ||||||||
| MiddleName: | SAGAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2018 BROOKWOOD MEDICAL CTR DR | ||||||||
| Address2: | POB 104 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058772707 | ||||||||
| FaxNumber: | 2058772783 | ||||||||
| Practice Location | |||||||||
| Address1: | 2018 BROOKWOOD MEDICAL CTR DR | ||||||||
| Address2: | POB 104 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352096898 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2058772707 | ||||||||
| FaxNumber: | 2058772783 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 03/03/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 27662 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.