Individual
RICHARD G DIETHELM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
48 MEDICAL PARK DR E, SUITE 351, BIRMINGHAM, AL 35235-3430
(205) 836-9366
Mailing address
48 MEDICAL PARK DR E, SUITE 351, BIRMINGHAM, AL 35235-3400
(205) 836-9366
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
26360
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009910701
—
AL
01
—
051005449
BLUE CROSS OF ALABAMA
AL
01
—
26360
MEDICAL LICENSE
AL
01
—
P00417763
RAILROAD MEDICARE
AL
Enumeration date
04/18/2007
Last updated
07/19/2011
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