Provider Demographics
NPI:1932324522
Name:DEHAAN, ALEXANDER PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:PAUL
Last Name:DEHAAN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:20952 E 12 MILE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3203
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:
Practice Address - Street 1:2093 HEALTH DR SW STE 202
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9691
Practice Address - Country:US
Practice Address - Phone:616-459-4171
Practice Address - Fax:616-531-7547
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2024-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016415208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D16060Medicare PIN