Healthcare Provider Details

I. General information

NPI: 1427630698
Provider Name (Legal Business Name): ALEX J SHAYKEVICH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MAIN ST NW
ELK RIVER MN
55330-1270
US

IV. Provider business mailing address

1615 15TH AVE SE APT 339
SAINT CLOUD MN
56304-2397
US

V. Phone/Fax

Practice location:
  • Phone: 855-324-7843
  • Fax:
Mailing address:
  • Phone: 917-685-4563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75231
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: