Provider Demographics
NPI:1285334169
Name:TEAGUE, ALEXANDER JEFFORY
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JEFFORY
Last Name:TEAGUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ADDISON AVE UNIT 609
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-3089
Mailing Address - Country:US
Mailing Address - Phone:630-930-4643
Mailing Address - Fax:
Practice Address - Street 1:231 ALBERT SABIN WAY
Practice Address - Street 2:ML 0558
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45267-3618
Practice Address - Country:US
Practice Address - Phone:513-558-4748
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program