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General NPI Number Information
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NPI Number | 1528164803
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Entity Type | Individual
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Provider Name | ALEX JOHN AUSEON DO
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Gender | Male
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 07/30/2025
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Provider Practice Location Address
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Address Line | 1000 CENTRAL ST STE 730
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City | EVANSTON
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State | IL
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Zip | 60201-1779
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Country | US
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Telephone | 847-864-3278
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Fax | 847-676-1727
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Provider Business Mailing Address
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Address Line | 2650 RIDGE AVE STE 1223
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City | EVANSTON
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State | IL
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Zip | 60201-1700
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Country | US
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Telephone | 847-570-2040
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Fax |
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 34007783
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 036105730
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License Number State | IL
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