Healthcare Provider Details

I. General information

NPI: 1841690096
Provider Name (Legal Business Name): JAMES ARUN ALEX MBBS,CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 N UNIVERSITY ST STE 104
PEORIA IL
61614-8300
US

IV. Provider business mailing address

315 E PINE AVE
WEST LAFAYETTE IN
47906-4885
US

V. Phone/Fax

Practice location:
  • Phone: 309-691-7774
  • Fax:
Mailing address:
  • Phone: 615-207-4674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code246ZX2200X
TaxonomyOrthopedic Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: