Healthcare Provider Details

I. General information

NPI: 1710333810
Provider Name (Legal Business Name): ALEXANDER BIGUS LADC, CADCII
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 04/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1246 UNIVERSITY AVE W STE 101
SAINT PAUL MN
55104-4125
US

IV. Provider business mailing address

1246 UNIVERSITY AVE W STE 101
SAINT PAUL MN
55104-4125
US

V. Phone/Fax

Practice location:
  • Phone: 651-558-9522
  • Fax:
Mailing address:
  • Phone: 651-558-9522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: