Provider Demographics
NPI:1508563156
Name:DUNHAM, ALEXIS A (PRC)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:A
Last Name:DUNHAM
Suffix:
Gender:F
Credentials:PRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 E MICHIGAN AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2894
Mailing Address - Country:US
Mailing Address - Phone:517-610-8257
Mailing Address - Fax:
Practice Address - Street 1:1601 E MICHIGAN AVE STE 1
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2894
Practice Address - Country:US
Practice Address - Phone:517-610-8257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist