Healthcare Provider Details

I. General information

NPI: 1548904204
Provider Name (Legal Business Name): ALEXANDER MARK SHRUM DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 W OUTER DR
DETROIT MI
48235-2624
US

IV. Provider business mailing address

PO BOX 174
HEBRON IN
46341-0174
US

V. Phone/Fax

Practice location:
  • Phone: 313-966-1020
  • Fax:
Mailing address:
  • Phone: 219-775-8614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number02008282A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: