Provider Demographics
NPI:1699846089
Name:MICHAEL, ALEXANDER III (MD)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MICHAEL
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 YANKEE PARK PL
Mailing Address - Street 2:STE A
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1838
Mailing Address - Country:US
Mailing Address - Phone:937-853-8014
Mailing Address - Fax:540-684-6181
Practice Address - Street 1:1550 YANKEE PARK PL
Practice Address - Street 2:STE A
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1838
Practice Address - Country:US
Practice Address - Phone:937-853-8014
Practice Address - Fax:540-684-6181
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043973208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0550985Medicaid
OH0550985Medicaid
OHMI0795381Medicare ID - Type Unspecified