Provider Demographics
NPI:1235919168
Name:CLOSSIN, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:CLOSSIN
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 1:16805 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44023-2317
Mailing Address - Country:US
Mailing Address - Phone:440-318-5314
Mailing Address - Fax:
Practice Address - Street 1:16805 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44023-2317
Practice Address - Country:US
Practice Address - Phone:440-318-5314
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver