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NPI Code Detail

MEDICARE: ALEXANDRA VIDOVSKA

MEDICARE: ALEXANDRA VIDOVSKA
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
1363LA2100XAcute Care Nurse Practitioner4704321932MI
2363L00000XNurse Practitioner4704321932MI

General Provider Information

NPI Number : 1679394183
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDRA VIDOVSKA
Provider Business Mailing Address
First Line : 1 FORD PL STE 3A
Second Line :
City : DETROIT
State : MI
Zip : 48202-3450
Country : US
Telephone Number : 800-999-5829
Fax Number : 313-876-1305
Provider Business Practice Location Address
First Line : 15855 19 MILE RD
Second Line :
City : CLINTON TOWNSHIP
State : MI
Zip : 48038-3504
Country : US
Telephone Number : 586-203-1195
Fax Number : 313-876-1305
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2024
Last Update Date : 02/02/2026

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Directions to “ ALEXANDRA VIDOVSKA ” Practice Location

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