MEDICARE: DR. SUSIE ALEXANDER M.D.

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	207Q00000X	Family Medicine Physician	17996	KS

General Provider Information

NPI Number	:	1548461049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSIE ALEXANDER M.D.

Provider Business Mailing Address
First Line	:	11648 W 146TH ST
Second Line	:
City	:	OLATHE
State	:	KS
Zip	:	66062-8410
Country	:	US
Telephone Number	:	913-685-8354
Fax Number	:	913-685-8354

Provider Business Practice Location Address
First Line	:	2323 RIDGE CT
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-3956
Country	:	US
Telephone Number	:	785-865-5300
Fax Number	:

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

Provider Enumeration Date	:	05/30/2007
Last Update Date	:	07/08/2007

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