Healthcare Provider Details

I. General information

NPI: 1447206537
Provider Name (Legal Business Name): ALEXANDRIA NEUROSURGICAL CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3704 NORTH BLVD SUITE C
ALEXANDRIA LA
71301-3606
US

IV. Provider business mailing address

3704 NORTH BLVD SUITE C
ALEXANDRIA LA
71301-3606
US

V. Phone/Fax

Practice location:
  • Phone: 318-443-4576
  • Fax: 318-449-5579
Mailing address:
  • Phone: 318-443-4576
  • Fax: 318-449-5579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL LAWRENCE DRERUP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 318-443-4576