Provider Demographics
NPI:1326268954
Name:BLAIVAS, ALEX S (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:S
Last Name:BLAIVAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:505 E HURON ST
Mailing Address - Street 2:APT 503
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-1573
Mailing Address - Country:US
Mailing Address - Phone:734-769-1475
Mailing Address - Fax:
Practice Address - Street 1:201 E LIBERTY ST
Practice Address - Street 2:STE 23
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-2118
Practice Address - Country:US
Practice Address - Phone:734-997-9729
Practice Address - Fax:734-997-9739
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43014067302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2617799Medicaid
MI2608221962OtherBCBS
MI4301406730OtherMI LICENSE
MI4301406730OtherMI LICENSE
MI8221962261Medicare ID - Type Unspecified
MI2608221962OtherBCBS