MEDICARE: DR. ALEXANDER BLAISE DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO3526	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750692539
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER BLAISE DPM

Provider Business Mailing Address
First Line	:	9640 NW 10TH CT
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322-4851
Country	:	US
Telephone Number	:	305-424-9301
Fax Number	:	305-424-9301

Provider Business Practice Location Address
First Line	:	3500 NW 17TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33142-5540
Country	:	US
Telephone Number	:	305-761-1262
Fax Number	:	306-675-8164

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	01/17/2019

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