Provider Demographics
NPI:1497855118
Name:YAKOVLEV, ALEXANDER E (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:E
Last Name:YAKOVLEV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:100 THEDA CLARK MEDICAL PLZ
Mailing Address - Street 2:SUITE 252
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2763
Mailing Address - Country:US
Mailing Address - Phone:920-733-7230
Mailing Address - Fax:920-729-0347
Practice Address - Street 1:820 E GRANT ST
Practice Address - Street 2:SUITE 335
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-3490
Practice Address - Country:US
Practice Address - Phone:920-733-7230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-23
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI36140-20208VP0014X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H38458Medicare UPIN