Provider Demographics
NPI:1669640504
Name:TODD D ALEXANDER MD SC
Entity Type:Organization
Organization Name:TODD D ALEXANDER MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-397-0077
Mailing Address - Street 1:1235 N MULFORD RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61107-3879
Mailing Address - Country:US
Mailing Address - Phone:815-397-0077
Mailing Address - Fax:815-397-0016
Practice Address - Street 1:1235 N MULFORD RD
Practice Address - Street 2:SUITE 210
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-397-0077
Practice Address - Fax:815-397-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087626207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDB6066OtherRAILROAD MEDICARE
IL10107489OtherBCBS ILLINOIS
IL207633Medicare PIN