Provider Demographics
NPI:1235313248
Name:BIBIKAU, ALEX (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:
Last Name:BIBIKAU
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:919 CANYON RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-5607
Mailing Address - Country:US
Mailing Address - Phone:203-951-5700
Mailing Address - Fax:203-951-5702
Practice Address - Street 1:265 BIC DR STE 102
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06461-3048
Practice Address - Country:US
Practice Address - Phone:203-951-5700
Practice Address - Fax:203-951-5702
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2016-06-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT046454207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110010653Medicare PIN