Healthcare Provider Details

I. General information

NPI: 1003358045
Provider Name (Legal Business Name): MICHAEL M ALEXANDER DO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2016
Last Update Date: 04/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3219 SULLIVANT AVE
COLUMBUS OH
43204-1837
US

IV. Provider business mailing address

3219 SULLIVANT AVE
COLUMBUS OH
43204-1837
US

V. Phone/Fax

Practice location:
  • Phone: 614-272-5244
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MICHAEL ALEXANDER
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 614-272-5244