| Richard G. Diethelm, Md, Pc | |
|
48 Medical Park Dr E Ste 351 Birmingham AL 35235-3467 | |
| (205) 836-9366 | |
| (205) 836-9367 |
| Full Name | Richard G. Diethelm, Md, Pc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 48 Medical Park Dr E Ste 351, Birmingham, Alabama |
| Authorized Official Name and Position | Richard G Diethelm (PRESIDENT) |
| Authorized Official Contact | 2058369366 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Richard G. Diethelm, Md, Pc 48 Medical Park Dr E Ste 351 Birmingham AL 35235-3467 Ph: (205) 836-9366 | Richard G. Diethelm, Md, Pc 48 Medical Park Dr E Ste 351 Birmingham AL 35235-3467 Ph: (205) 836-9366 |
| NPI Number | 1205053824 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 05/13/2024 |
| Certification Date | 05/13/2024 |
| Medicare PECOS PAC ID | 0143329474 |
|---|---|
| Medicare Enrollment ID | O20070627000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205053824 | NPI | - | NPPES |
| DG1281 | Other | AL | RAILROAD MEDICARE |
| 529932807 | Medicaid | AL | |
| 009910701 | Medicaid | AL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | 26360 (Alabama) | Primary |
| Provider Name | Richard G Diethelm |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851518476 PECOS PAC ID: 0042319378 Enrollment ID: I20070627000084 |
| Provider Name | Andrea L Sutton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467725267 PECOS PAC ID: 0345404042 Enrollment ID: I20120608000370 |
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