Provider Demographics
NPI:1750324034
Name:CANGE, ALIX ANDRE (PA)
Entity Type:Individual
Prefix:
First Name:ALIX
Middle Name:ANDRE
Last Name:CANGE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 NW 49TH ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-3723
Mailing Address - Country:US
Mailing Address - Phone:954-714-6351
Mailing Address - Fax:954-714-6335
Practice Address - Street 1:200 NW 7TH AVE
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-9026
Practice Address - Country:US
Practice Address - Phone:954-714-6351
Practice Address - Fax:954-714-6335
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104367363A00000X
CT5777363A00000X
NY010303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5681L1Medicare ID - Type Unspecified
Q28805Medicare UPIN