Healthcare Provider Details

I. General information

NPI: 1164694584
Provider Name (Legal Business Name): ALEXANDRA KROT DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 BASSETT PLACE
BLOOMFIELD HILLS MI
48301
US

IV. Provider business mailing address

169 BASSETT PLACE
BLOOMFIELD HILLS MI
48301
US

V. Phone/Fax

Practice location:
  • Phone: 248-981-4657
  • Fax: 313-365-5241
Mailing address:
  • Phone: 248-981-4657
  • Fax: 313-365-5241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number5101006356
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number5101006356
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License Number5101006356
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: