Healthcare Provider Details

I. General information

NPI: 1942905021
Provider Name (Legal Business Name): ALEXANDRA ZOE MICHALOPOULOS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2023
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 WINDY HILL RD SE STE 206
MARIETTA GA
30067-8654
US

IV. Provider business mailing address

1330 MEDINAH DR
ITASCA IL
60143-1968
US

V. Phone/Fax

Practice location:
  • Phone: 404-228-9892
  • Fax:
Mailing address:
  • Phone: 630-888-8244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD305091
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: