Healthcare Provider Details

I. General information

NPI: 1770525776
Provider Name (Legal Business Name): ALEXANDER ROBERT SPITZER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/15/2021
Certification Date: 11/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 CEDAR CT
MACKINAC ISLAND MI
49757
US

IV. Provider business mailing address

PO BOX 2005
MACKINAC ISLAND MI
49757-2005
US

V. Phone/Fax

Practice location:
  • Phone: 906-847-6151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number35-124028
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number62879
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number63081
License Number StateMN
# 4
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number050874
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: