Basic Information
| Provider Information | |||||||||
| NPI: | 1881866846 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KELLEHER | ||||||||
| FirstName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 55823 | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352555823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059962244 | ||||||||
| FaxNumber: | 2059962254 | ||||||||
| Practice Location | |||||||||
| Address1: | 619 19TH ST S | ||||||||
| Address2: | 525 NHB | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352491900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059344680 | ||||||||
| FaxNumber: | 2059343100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2008 | ||||||||
| LastUpdateDate: | 03/31/2008 | ||||||||
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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 | 2080N0001X | L2938R | AL | Y | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine |
No ID Information.