Healthcare Provider Details

I. General information

NPI: 1700890506
Provider Name (Legal Business Name): ALEXANDER E TZOUANAKIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 12/18/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

166 PASADENA DR
LEXINGTON KY
40503-2973
US

IV. Provider business mailing address

PO BOX 910670
LEXINGTON KY
40591-0670
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-0319
  • Fax: 859-277-9699
Mailing address:
  • Phone: 859-971-4685
  • Fax: 859-971-4602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number31001
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: