Provider Demographics
NPI:1467438994
Name:ALEXANDER, THERESA M (MD)
Entity Type:Individual
Prefix:DR
First Name:THERESA
Middle Name:M
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1006 S EDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:KNOX
Mailing Address - State:IN
Mailing Address - Zip Code:46534-8226
Mailing Address - Country:US
Mailing Address - Phone:574-772-5505
Mailing Address - Fax:574-772-6151
Practice Address - Street 1:1006 S EDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:KNOX
Practice Address - State:IN
Practice Address - Zip Code:46534-8226
Practice Address - Country:US
Practice Address - Phone:574-772-5505
Practice Address - Fax:574-772-6151
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045409A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200441390AMedicaid
IN200118110Medicaid
IN210420Medicare ID - Type UnspecifiedGROUP
IN200118110Medicaid
ING98557Medicare UPIN