Individual
SAM IDONGESIT MICHAEL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
12205 COUNTY LINE RD STE D, MADISON, AL 35758-7720
(938) 227-6307
Mailing address
625 19TH ST S, BIRMINGHAM, AL 35233-1900
(205) 934-2490
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD.39065
AL
207RC0000X
Cardiovascular Disease Physician
39065
AL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/11/2018
Last updated
10/30/2025
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