Provider Demographics
NPI:1255302576
Name:BOZANICH, ALEXANDER S (MD)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:S
Last Name:BOZANICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1104
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1104
Mailing Address - Country:US
Mailing Address - Phone:219-836-2449
Mailing Address - Fax:219-836-2953
Practice Address - Street 1:7550 HOHMAN AVE STE 600
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1065
Practice Address - Country:US
Practice Address - Phone:219-836-2449
Practice Address - Fax:219-836-2953
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01047404A207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0090001354OtherBCBS IL
INP00466655OtherMEDICAR RR PTAN
IN200158760Medicaid
IN000000544215OtherBCBS IN
IL0090001354OtherBCBS IL
IN255140Medicare PIN