Provider Demographics
NPI:1528164803
Name:AUSEON, ALEX JOHN (DO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:JOHN
Last Name:AUSEON
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 1:2650 RIDGE AVE STE 1223
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-1700
Mailing Address - Country:US
Mailing Address - Phone:847-570-2040
Mailing Address - Fax:
Practice Address - Street 1:1000 CENTRAL ST STE 730
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-1779
Practice Address - Country:US
Practice Address - Phone:847-864-3278
Practice Address - Fax:847-676-1727
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007783207RC0000X
IL036105730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2696346Medicaid
OH2696346Medicaid
OHAU4197051Medicare PIN