Provider Demographics
NPI:1538691381
Name:TUNGESVIK, ALEXANDRE MARK (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRE
Middle Name:MARK
Last Name:TUNGESVIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 E BROADWAY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-7167
Mailing Address - Country:US
Mailing Address - Phone:573-874-7800
Mailing Address - Fax:573-607-3878
Practice Address - Street 1:1705 E BROADWAY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-7167
Practice Address - Country:US
Practice Address - Phone:573-874-7800
Practice Address - Fax:573-607-3878
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA47265207RH0003X
390200000X
MO2023011840207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program