Provider Demographics
NPI:1043347248
Name:ALEXANDER, MICHAEL J (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 S. SAN VICENTE BLVD.
Mailing Address - Street 2:SUITE A6600
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:310-423-4420
Mailing Address - Fax:310-423-0810
Practice Address - Street 1:127 S. SAN VICENTE BLVD.
Practice Address - Street 2:SUITE A6600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:310-423-4420
Practice Address - Fax:310-423-0810
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77195207T00000X, 2085R0204X
NC2000-010512085R0202X, 207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8912651Medicaid
NC2280911Medicare ID - Type Unspecified
NC8912651Medicaid