Provider Demographics
NPI:1528164803
Name:AUSEON, ALEX J (DO)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:J
Last Name:AUSEON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:840 S WOOD ST # MC715
Mailing Address - Street 2:SUITE 920 S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-4325
Mailing Address - Country:US
Mailing Address - Phone:312-996-6730
Mailing Address - Fax:312-413-2948
Practice Address - Street 1:840 S WOOD ST # MC715
Practice Address - Street 2:SUITE 920 S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-4325
Practice Address - Country:US
Practice Address - Phone:312-996-6730
Practice Address - Fax:312-413-2948
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2015-04-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH34007783207RC0000X
IL036.105730207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2696346Medicaid
OH2696346Medicaid
OHAU4197051Medicare PIN