Basic Information
Provider Information
NPI: 1801829833
EntityType: 2
ReplacementNPI:  
OrganizationName: SIMON MIRELMAN UROLOGY, PC
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Mailing Information
Address1: 2204 LAKESHORE DRIVE
Address2: SUITE 220
City: BIRMINGHAM
State: AL
PostalCode: 35209
CountryCode: US
TelephoneNumber: 2058748300
FaxNumber: 2058748333
Practice Location
Address1: 513 BROAKWOOD BLVD
Address2: SUITE 500
City: BIRMINGHAM
State: AL
PostalCode: 35209
CountryCode: US
TelephoneNumber: 2058772767
FaxNumber: 2058772914
Other Information
ProviderEnumerationDate: 07/10/2006
LastUpdateDate: 04/29/2008
NPIDeactivationReasonCode:  
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AuthorizedOfficialLastName: MIRELMAN
AuthorizedOfficialFirstName: SIMON
AuthorizedOfficialMiddleName: WEISS
AuthorizedOfficialTitleorPosition: OWNER
AuthorizedOfficialTelephone: 2058748300
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: DR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208800000X  Y193400000X SINGLE SPECIALTY GROUPAllopathic & Osteopathic PhysiciansUrology 

ID Information
IDTypeStateIssuerDescription
00005177605AL MEDICAID
00991039405AL MEDICAID
52993287005AL MEDICAID


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