Healthcare Provider Details

I. General information

NPI: 1265526040
Provider Name (Legal Business Name): INGRID I. ALEXANDER, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901OLD JACKSONVILLE ROAD
SPRINGFIELD IL
62704
US

IV. Provider business mailing address

340 W. MILLER ST
SPRINGFIELD IL
62702
US

V. Phone/Fax

Practice location:
  • Phone: 217-697-9722
  • Fax:
Mailing address:
  • Phone: 217-789-0668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number StateIL

VIII. Authorized Official

Name: INGRID I ALEXANDER
Title or Position: MD
Credential: MD
Phone: 217-698-9722