Healthcare Provider Details

I. General information

NPI: 1477049260
Provider Name (Legal Business Name): ALEXANDER ICARDI DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

IV. Provider business mailing address

21230 DEQUINDRE RD
WARREN MI
48091-2279
US

V. Phone/Fax

Practice location:
  • Phone: 586-427-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number5901002742
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: