Healthcare Provider Details

I. General information

NPI: 1841951936
Provider Name (Legal Business Name): ALEXA BROOKE PLUTA RVT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/01/2022
Last Update Date: 01/01/2022
Certification Date: 01/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 E MICHIGAN AVE
LANSING MI
48912-1805
US

IV. Provider business mailing address

4638 S JACKSON RD
JACKSON MI
49201-8303
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-9650
  • Fax:
Mailing address:
  • Phone: 517-745-6458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number206691
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: