Healthcare Provider Details

I. General information

NPI: 1427896620
Provider Name (Legal Business Name): ALEXANDER MOSTELLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2024
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HAWKINS DR
IOWA CITY IA
52242-1009
US

IV. Provider business mailing address

633 N WOODBRIDGE DR
BLOOMINGTON IN
47408-2752
US

V. Phone/Fax

Practice location:
  • Phone: 319-356-1616
  • Fax:
Mailing address:
  • Phone: 812-430-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: