Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 07001343A | IN |
N | 222Z00000X | Podiatrist | 07001343A | IN |
N | 213E00000X | Podiatrist | POD001404 | GA |
N | 222Z00000X | Podiatrist | POD001404 | GA |
Y | 213ES0103X | Foot & Ankle Surgery | 016.005918 | IL |
NPI | 1073078085 |
---|---|
Provider Name | Dr. Kevin Alexander |
First Address | Elgin, IL 60123-4703 |
Second Address | Elgin, IL 60123-4703 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/02/2019 |
Last Update Date | 07/12/2021 |