Provider Demographics
NPI:1427207281
Name:CHESROW, ALEXIS M (MD)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:M
Last Name:CHESROW
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 1:1415 TULANE AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-2600
Mailing Address - Country:US
Mailing Address - Phone:504-988-5271
Mailing Address - Fax:504-988-7655
Practice Address - Street 1:1415 TULANE AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5271
Practice Address - Fax:504-988-7655
Is Sole Proprietor?:No
Enumeration Date:2008-09-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55261-20208800000X
IL036123327208800000X
CAA108405208800000X
AZ61996208800000X, 2088F0040X
LA3346212088F0040X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2607600Medicaid
AZ085394Medicaid