Provider Demographics
NPI:1952033383
Name:TANGALOS, ALEXANDRA MARINA (MD)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:MARINA
Last Name:TANGALOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 N LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-2048
Mailing Address - Country:US
Mailing Address - Phone:248-437-6300
Mailing Address - Fax:248-437-3245
Practice Address - Street 1:210 N LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-2048
Practice Address - Country:US
Practice Address - Phone:248-437-6300
Practice Address - Fax:248-437-3245
Is Sole Proprietor?:No
Enumeration Date:2022-06-24
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program