Provider Demographics
NPI:1316907819
Name:VEGA, ALEJANDRO A (MD)
Entity type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:A
Last Name:VEGA
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 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-865-8133
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1104 E GRACE ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-3211
Practice Address - Country:US
Practice Address - Phone:219-866-5141
Practice Address - Fax:219-866-3234
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056591A208M00000X, 207R00000X
GA78871208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200826160Medicaid
KY64123896Medicaid
IN200826160Medicaid
KY64123896Medicaid
INP00388059OtherRAILROAD MEDICARE
IN000000480774OtherANTHEM BC/BS
KY64123896Medicaid
IN000000480774OtherANTHEM BC/BS