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General NPI Number Information
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NPI Number | 1356405757
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Entity Type | Individual
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Provider Name | MICHAEL ALEXA CRNA
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Gender | Male
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 06/19/2009
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Provider Practice Location Address
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Address Line | 680 N LAKE SHORE DR SUITE 1000
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City | CHICAGO
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State | IL
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Zip | 60611-4546
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Country | US
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Telephone | 312-926-2185
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Fax | 312-926-1677
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Provider Business Mailing Address
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Address Line | 251 E. HURON FEINBER LC-736
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City | CHICAGO
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State | ILLINOIS
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Zip | 60611
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Country | UM
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Telephone | 312-926-2185
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Fax | 312-926-1677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209-006294
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License Number State | IL
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