Healthcare Provider Details

I. General information

NPI: 1366450009
Provider Name (Legal Business Name): ALEXIS CIRILLI WHALEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 11/03/2022
Certification Date: 11/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 S STEPHENSON AVE SUITE 210
IRON MOUNTAIN MI
49801-3639
US

IV. Provider business mailing address

PO BOX 549
IRON MOUNTAIN MI
49801-0549
US

V. Phone/Fax

Practice location:
  • Phone: 906-776-5800
  • Fax: 906-776-5801
Mailing address:
  • Phone: 906-774-1313
  • Fax: 906-776-5639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301088606
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number70729
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number4301088606
License Number StateMI
# 4
Primary TaxonomyN
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number70729
License Number StateMT
# 5
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMEDS6509
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: