Healthcare Provider Details

I. General information

NPI: 1508209842
Provider Name (Legal Business Name): ALEXANDER MATTHEW HUBBELL MD/MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2013
Last Update Date: 07/29/2024
Certification Date: 07/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S STE 600
MINNEAPOLIS MN
55454-5020
US

IV. Provider business mailing address

606 24TH AVE S STE 600
MINNEAPOLIS MN
55454-5020
US

V. Phone/Fax

Practice location:
  • Phone: 800-468-3120
  • Fax: 612-273-9945
Mailing address:
  • Phone: 800-468-3120
  • Fax: 612-273-9945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number58587
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: