Individual
PETER N KOLETTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
619 19TH STREET SOUTH, BIRMINGHAM, AL 35233
(205) 934-4011
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
21684
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000075778
BLUE CROSS
AL
05
—
000075778
—
AL
01
—
05953821
MISSISSIPPI MEDICAID
MS
01
—
340015713
RAILROAD MEDICARE
AL
01
—
G78806
VIVA
AL
Enumeration date
06/29/2006
Last updated
05/06/2026
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