Provider Demographics
NPI:1215939301
Name:KAJDOS, IVANA BARBARA (MD)
Entity type:Individual
Prefix:
First Name:IVANA
Middle Name:BARBARA
Last Name:KAJDOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 22ND ST S
Mailing Address - Street 2:STE 1000
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-2881
Mailing Address - Country:US
Mailing Address - Phone:205-385-0630
Mailing Address - Fax:205-385-0645
Practice Address - Street 1:3400 HIGHWAY 78 E
Practice Address - Street 2:MEDICAL ARTS TOWER, SUITE 321
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35501-8907
Practice Address - Country:US
Practice Address - Phone:205-385-0630
Practice Address - Fax:205-385-0645
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL10598207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C73549Medicare UPIN
AL000018014Medicare ID - Type Unspecified