Provider Demographics
NPI:1558332874
Name:RESTREPO, ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:RESTREPO
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 1:160 JOHN F KENNEDY DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-434-0060
Mailing Address - Fax:561-434-0086
Practice Address - Street 1:160 JOHN F KENNEDY DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-434-0060
Practice Address - Fax:561-434-0086
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9491207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL083016PNKMedicare ID - Type Unspecified
H00232Medicare UPIN