Healthcare Provider Details

I. General information

NPI: 1346159886
Provider Name (Legal Business Name): ALEXANDER ODETTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 RACKHAM BUILDING
YPSILANTI MI
48197
US

IV. Provider business mailing address

1605 MEADHURST DR
YPSILANTI MI
48198-8408
US

V. Phone/Fax

Practice location:
  • Phone: 734-487-2843
  • Fax:
Mailing address:
  • Phone: 810-406-9377
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: