Healthcare Provider Details

I. General information

NPI: 1033650445
Provider Name (Legal Business Name): ALEXANDER MOLTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2017
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 10TH ST S
LA CROSSE WI
54601-4768
US

IV. Provider business mailing address

2200 GENOA BUSINESS PARK DR STE 100
BRIGHTON MI
48114-5328
US

V. Phone/Fax

Practice location:
  • Phone: 608-785-0940
  • Fax: 734-786-4915
Mailing address:
  • Phone: 517-492-0517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number75377
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberEMC0006408
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: