Provider Demographics
NPI:1306224811
Name:DEMARE, ALEXANDER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:MICHAEL
Last Name:DEMARE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3565 DALEFORD RD
Mailing Address - Street 2:
Mailing Address - City:SHAKER HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44120-5230
Mailing Address - Country:US
Mailing Address - Phone:248-953-5558
Mailing Address - Fax:
Practice Address - Street 1:3577 W 13 MILE RD STE 201
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-551-7890
Practice Address - Fax:248-551-8895
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-16
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35141330208600000X
MI4301507296208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0439619Medicaid