Healthcare Provider Details

I. General information

NPI: 1134816424
Provider Name (Legal Business Name): ALEXIS PAYNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 N CENTER AVE STE 130
GAYLORD MI
49735-1684
US

IV. Provider business mailing address

829 N CENTER AVE STE 130
GAYLORD MI
49735-1684
US

V. Phone/Fax

Practice location:
  • Phone: 989-731-7930
  • Fax: 989-731-7948
Mailing address:
  • Phone: 989-731-7930
  • Fax: 989-731-7948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301518088
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: