Basic Information
| Provider Information | |||||||||
| NPI: | 1871848929 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PUTMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DENNIS | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | II | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 805 SAINT VINCENTS DR | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055955504 | ||||||||
| FaxNumber: | 2055923427 | ||||||||
| Practice Location | |||||||||
| Address1: | 805 SAINT VINCENTS DR | ||||||||
| Address2: | SUITE 510 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352051636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055955504 | ||||||||
| FaxNumber: | 2055923427 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2012 | ||||||||
| LastUpdateDate: | 12/06/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | L3313.R | AL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1871848929 | 01 | AL | NPI | OTHER |