Individual
DR. BRUNDA REVANNA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1509 6TH AVE S, BIRMINGHAM, AL 35233-1601
(205) 930-3200
(205) 521-5524
Mailing address
PO BOX 55407, BIRMINGHAM, AL 35255-5407
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00025426
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009930945
—
AL
01
—
051517109
AL BCBS
—
01
—
270060909
TRICARE
—
Enumeration date
02/07/2006
Last updated
08/21/2025
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