Provider Demographics
NPI:1225427099
Name:ALEXANDER, DWAYLON
Entity Type:Individual
Prefix:
First Name:DWAYLON
Middle Name:
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33200 SCHOOLCRAFT RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-1643
Mailing Address - Country:US
Mailing Address - Phone:313-516-4545
Mailing Address - Fax:
Practice Address - Street 1:33200 SCHOOLCRAFT RD
Practice Address - Street 2:STE. 107
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-1643
Practice Address - Country:US
Practice Address - Phone:313-516-4545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-16
Last Update Date:2015-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172A00000X172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver