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Organization
SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC
Active
Organization
SOUTHLAKE ORTHOPAEDICS SPORTS MEDICINE & SPINE CENTER PC
Active
Other names
Southlake Orthopaedics
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL FRANCES BLUM (PRESIDENT)
(205) 985-4111
Entity
Organization
Contact information
Practice address
4517 SOUTHLAKE PKWY, BIRMINGHAM, AL 35244-3280
(205) 985-4111
(205) 985-4326
Mailing address
4517 SOUTHLAKE PKWY, HOOVER, AL 35244-3280
(205) 985-4111
(205) 985-4326
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
9307
AL
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
—
—
222Z00000X
Orthotist
—
—
224L00000X
Pedorthist
—
—
224P00000X
Prosthetist
—
—
225000000X
Orthotic Fitter
—
—
225100000X
Physical Therapist
—
—
225X00000X
Occupational Therapist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
529802230
—
AL
01
—
G715
MEDICARE
AL
Enumeration date
05/05/2006
Last updated
02/10/2022
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