Provider Demographics
NPI:1033679493
Name:AMIN, SHIVAM VIPUL (MD)
Entity type:Individual
Prefix:
First Name:SHIVAM
Middle Name:VIPUL
Last Name:AMIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:2101 HIGHLAND AVE S STE 350
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-4009
Mailing Address - Country:US
Mailing Address - Phone:334-263-0105
Mailing Address - Fax:334-264-4386
Practice Address - Street 1:2055 NORMANDIE DR STE 314
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2732
Practice Address - Country:US
Practice Address - Phone:334-263-0105
Practice Address - Fax:334-264-4386
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL125073564207W00000X
WI81518207W00000X
ALMD.50972207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology