Provider Demographics
NPI:1922116375
Name:MARKOVICH, ALEX (MS PT)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:
Last Name:MARKOVICH
Suffix:
Gender:M
Credentials:MS PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 N 2ND ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NILES
Mailing Address - State:MI
Mailing Address - Zip Code:49120-2259
Mailing Address - Country:US
Mailing Address - Phone:269-687-9594
Mailing Address - Fax:269-687-9543
Practice Address - Street 1:20 N 2ND ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NILES
Practice Address - State:MI
Practice Address - Zip Code:49120-2259
Practice Address - Country:US
Practice Address - Phone:269-687-9594
Practice Address - Fax:269-687-9543
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501010439225100000X
IN232410225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232410AMedicare PIN
MIN14720002Medicare PIN