Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | 0104001349 | VA |
N | 111NN0400X | Neurology | 038.012332 | IL |
Y | 111NN0400X | Neurology | 4717-12 | WI |
NPI | 1780893628 |
---|---|
Provider Name | Dr. Keith Adam Alexander |
First Address | Pleasant Prairie, WI 53158-5336 |
Second Address | Pleasant Prairie, WI 53158-5336 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/05/2007 |
Last Update Date | 22/05/2013 |