Provider Demographics
NPI:1992988976
Name:PC ALEXANDER,M.D.,INC
Entity type:Organization
Organization Name:PC ALEXANDER,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:PANOS
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-864-5730
Mailing Address - Street 1:3611 S REED RD STE 108
Mailing Address - Street 2:
Mailing Address - City:KOKOMO
Mailing Address - State:IN
Mailing Address - Zip Code:46902-3828
Mailing Address - Country:US
Mailing Address - Phone:765-864-5730
Mailing Address - Fax:765-864-5731
Practice Address - Street 1:3611 S REED RD STE 108
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46902-3828
Practice Address - Country:US
Practice Address - Phone:765-864-5730
Practice Address - Fax:765-864-5731
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033461A208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100187200BMedicaid
IL=========OtherOTHER
IN216350Medicare PIN