Healthcare Provider Details

I. General information

NPI: 1952233843
Provider Name (Legal Business Name): ALEXANDRA VALENTINE EICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ALLY EICK PA-C

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 GREENWOOD ST
BIRMINGHAM MI
48009-1341
US

IV. Provider business mailing address

559 GREENWOOD ST
BIRMINGHAM MI
48009-1341
US

V. Phone/Fax

Practice location:
  • Phone: 248-885-6867
  • Fax:
Mailing address:
  • Phone: 248-885-6867
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601014050
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: