Healthcare Provider Details

I. General information

NPI: 1750324034
Provider Name (Legal Business Name): ALIX ANDRE CANGE PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NW 7TH AVE
FT LAUDERDALE FL
33311-9026
US

IV. Provider business mailing address

1501 NW 49TH ST SUITE 140
FORT LAUDERDALE FL
33309-3723
US

V. Phone/Fax

Practice location:
  • Phone: 954-714-6351
  • Fax: 954-714-6335
Mailing address:
  • Phone: 954-714-6351
  • Fax: 954-714-6335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5777
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104367
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010303
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10004908A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: