Provider Demographics
NPI:1871591503
Name:ZILBERMAN, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:ZILBERMAN
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86405-0008
Mailing Address - Country:US
Mailing Address - Phone:928-854-6500
Mailing Address - Fax:928-854-6206
Practice Address - Street 1:340 S WILLARD ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-4126
Practice Address - Country:US
Practice Address - Phone:928-639-6025
Practice Address - Fax:928-649-7921
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31136208600000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0728500OtherAZ BC/BS PROVIDER NUMBER
AZAZ0735650OtherCHAMPUS TRICARE NUMBER
AZ020054732OtherRAILROAD MEDICARE
AZ753261Medicaid
AZ74526Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER