MEDICARE: COLLEEN ALEXANDER MD MS RD LD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	LD004414	GA
2	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	100469	WI

General Provider Information

NPI Number	:	1417322405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN ALEXANDER MD MS RD LD

Provider Business Mailing Address
First Line	:	600 HIGHLAND AVE
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53792-0001
Country	:	US
Telephone Number	:	608-263-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	749 UNIVERSITY ROW STE 200
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-1465
Country	:	US
Telephone Number	:	608-263-6400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2015
Last Update Date	:	06/14/2023

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