Healthcare Provider Details

I. General information

NPI: 1396662789
Provider Name (Legal Business Name): ALEXANDRA SURGALSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 HARRISON ST
FLINT MI
48502
US

IV. Provider business mailing address

509 HARRISON ST
FLINT MI
48502
US

V. Phone/Fax

Practice location:
  • Phone: 248-935-9915
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4704340951
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: