Healthcare Provider Details

I. General information

NPI: 1356761860
Provider Name (Legal Business Name): ALEXANDER SHIKHMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2014
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MIAMI VALLEY DR
CENTERVILLE OH
45459-4774
US

IV. Provider business mailing address

2400 MIAMI VALLEY DR STE 280
CENTERVILLE OH
45459-4774
US

V. Phone/Fax

Practice location:
  • Phone: 937-435-4263
  • Fax:
Mailing address:
  • Phone: 937-435-4263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number34.014121
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: