Healthcare Provider Details

I. General information

NPI: 1023513553
Provider Name (Legal Business Name): ALEXANDER JOSEPH CANIGLIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 07/10/2023
Certification Date: 07/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

170 W 106TH ST
CARMEL IN
46290-1004
US

IV. Provider business mailing address

9290 E THOMPSON PEAK PKWY UNIT 489
SCOTTSDALE AZ
85255-4519
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-0330
  • Fax:
Mailing address:
  • Phone: 602-377-2504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number01089718A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: