Basic Information
| Provider Information | |||||||||
| NPI: | 1669536280 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DEVI P. MISRA M.D.,F.A.C.P | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 WHITESPORT DR SW | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568800455 | ||||||||
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| Practice Location | |||||||||
| Address1: | 400 WHITESPORT DR SW | ||||||||
| Address2: | SUITE 103 | ||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358016452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2568800455 | ||||||||
| FaxNumber: | 2568826382 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/20/2006 | ||||||||
| LastUpdateDate: | 05/28/2009 | ||||||||
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| AuthorizedOfficialLastName: | MISRA | ||||||||
| AuthorizedOfficialFirstName: | DEVI | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2568800455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RP1001X | 9102 | AL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 411013507 | 01 | AL | MEDICARE RAILROAD | OTHER | 000004729 | 05 | AL | MEDICAID | 051004729 | 01 | AL | BLUE CROSS BLUE SHIELD | OTHER |