Provider Demographics
NPI:1346223161
Name:ALEXIS, ATHLENE A (MD)
Entity Type:Individual
Prefix:DR
First Name:ATHLENE
Middle Name:A
Last Name:ALEXIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 S EXECUTIVE DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4266
Mailing Address - Country:US
Mailing Address - Phone:262-787-4026
Mailing Address - Fax:
Practice Address - Street 1:10200 W INNOVATION DR
Practice Address - Street 2:SUITE 700
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-4825
Practice Address - Country:US
Practice Address - Phone:414-302-9196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI34901207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32112900Medicaid
050049470OtherRAIL ROAD MEDICARE
WI32112900Medicaid
WI0001-73038Medicare ID - Type UnspecifiedPROVIDER NUMBER
050049470OtherRAIL ROAD MEDICARE