Provider Demographics
NPI:1528105897
Name:COLQUE, ALEX (MD)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:COLQUE
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 1:21675 E. MORELAND BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53186-2906
Mailing Address - Country:US
Mailing Address - Phone:262-781-9000
Mailing Address - Fax:262-395-4068
Practice Address - Street 1:21675 E. MORELAND BLVD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-2906
Practice Address - Country:US
Practice Address - Phone:262-781-9000
Practice Address - Fax:262-395-4068
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55219020208200000X, 2082S0099X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the Hand
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIWI2477001Medicare PIN