Provider Demographics
NPI:1073754321
Name:BAUTISTA, ALEXANDER FRANCISCO (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:FRANCISCO
Last Name:BAUTISTA
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-558-8949
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:130 HUNTER STATION WAY
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-8930
Practice Address - Country:US
Practice Address - Phone:812-283-2369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-17
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY52172207L00000X
IN01074052A207L00000X, 207LP2900X
OK31063207LP2900X
KY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY52172OtherLICENSE
IN01074052AOtherSTATE LICENSE
IN300022245Medicaid
KYK277960OtherMEDICARE
KY7100166170Medicaid