Provider Demographics
NPI:1659960813
Name:YUZEFOVICH, ALEXANDER (LAC)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:YUZEFOVICH
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5733 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-2108
Mailing Address - Country:US
Mailing Address - Phone:612-425-9117
Mailing Address - Fax:
Practice Address - Street 1:6250 EXCELSIOR BLVD STE 204
Practice Address - Street 2:
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-2735
Practice Address - Country:US
Practice Address - Phone:612-822-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist