Provider Demographics
NPI:1306805825
Name:MIRELMAN, DANIEL (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:MIRELMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 313 ACC
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6808
Mailing Address - Country:US
Mailing Address - Phone:205-877-2910
Mailing Address - Fax:205-879-4649
Practice Address - Street 1:2022 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 313 ACC
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6808
Practice Address - Country:US
Practice Address - Phone:205-877-2910
Practice Address - Fax:205-879-4649
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8570208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000001112Medicaid
1306805825OtherNPI
AL406283026OtherRAILROAD MEDICARE
AL510-01112OtherBLUE CROSS BLUE SHIELD
1922068774OtherGROUP NPI NUMBER
63-0677675OtherFEDERAL TAX ID
63-0677675OtherFEDERAL TAX ID
000001112Medicare ID - Type Unspecified
AL510-01112OtherBLUE CROSS BLUE SHIELD