Healthcare Provider Details

I. General information

NPI: 1013342427
Provider Name (Legal Business Name): ALEXANDRA MEW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2013
Last Update Date: 09/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47100 SCHOENHERR RD SUITE D
SHELBY TOWNSHIP MI
48315-4716
US

IV. Provider business mailing address

2223 CRYSTAL DR
ROCHESTER HILLS MI
48309-3755
US

V. Phone/Fax

Practice location:
  • Phone: 586-685-0505
  • Fax: 586-685-0501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: