Provider Demographics
NPI:1285790147
Name:PLESZYNSKI-PLATZ, ALEXANDER (MD)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:PLESZYNSKI-PLATZ
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 1:205 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:IL
Mailing Address - Zip Code:62946-1256
Mailing Address - Country:US
Mailing Address - Phone:574-772-6030
Mailing Address - Fax:574-772-7494
Practice Address - Street 1:2230 EDSEL LN NW STE 1
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2136
Practice Address - Country:US
Practice Address - Phone:812-734-0303
Practice Address - Fax:812-225-5145
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047322A207P00000X, 207Q00000X, 208D00000X, 208VP0014X
IL036-067712207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN036067712Medicaid
IL036067712-1Medicaid
IN200897290AMedicaid
IL3932056OtherBLUE SHIELD
IL3932056OtherBLUE SHIELD
IL214881042Medicare PIN
D89943Medicare UPIN
IN036067712Medicaid