Provider Demographics
NPI:1548427966
Name:SHALHOUB, ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SHALHOUB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 S PROSPECT
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198
Mailing Address - Country:US
Mailing Address - Phone:734-547-4870
Mailing Address - Fax:734-547-4871
Practice Address - Street 1:135 S. PROSPECT
Practice Address - Street 2:ROOM 2901 ANESTHESIOLOGY
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198
Practice Address - Country:US
Practice Address - Phone:734-547-4870
Practice Address - Fax:734-547-4871
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016081207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology