Provider Demographics
NPI:1679524789
Name:ALEXANDER, MICHAEL M (DO)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3219 SULLIVANT AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43204-1886
Mailing Address - Country:US
Mailing Address - Phone:614-272-5244
Mailing Address - Fax:614-272-9841
Practice Address - Street 1:3219 SULLIVANT AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43204-1886
Practice Address - Country:US
Practice Address - Phone:614-272-5244
Practice Address - Fax:614-272-9841
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34004400A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0714909Medicaid
OH000000119181OtherBLUE CROSS BLUE SHIELD
OH0714909Medicaid
E00775Medicare UPIN