Provider Demographics
NPI:1972572139
Name:ALEXANDER, TODD DAVID (MD SC)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:DAVID
Last Name:ALEXANDER
Suffix:
Gender:M
Credentials:MD SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5875 E RIVERSIDE BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-4937
Mailing Address - Country:US
Mailing Address - Phone:815-381-7431
Mailing Address - Fax:
Practice Address - Street 1:5875 E RIVERSIDE BLVD
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-4937
Practice Address - Country:US
Practice Address - Phone:815-381-7431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036087626207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036087626Medicaid
ILDB6066OtherRAILROAD MEDICARE GROUP NUMBER
IL10107489OtherBLUE CROSS BLUE SHIELD
IL140007501OtherRAILROAD MEDICARE PTAN
ILK02198Medicare ID - Type UnspecifiedMEDICARE MEMBER #
IL10107489OtherBLUE CROSS BLUE SHIELD
ILG21470Medicare UPIN