Provider Demographics
NPI:1306349741
Name:FIFFICK, ALEXA NICOLE (DO, MBS)
Entity type:Individual
Prefix:DR
First Name:ALEXA
Middle Name:NICOLE
Last Name:FIFFICK
Suffix:
Gender:F
Credentials:DO, MBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WYNDGATE CT
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2997
Mailing Address - Country:US
Mailing Address - Phone:440-668-7067
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3993
Practice Address - Country:US
Practice Address - Phone:216-444-6601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.015127207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH009242OtherCLEVELAND CLINIC EMPLOYEE ID