Provider Demographics
NPI:1023290780
Name:ALPHA PHYSICIANS, PLLC
Entity type:Organization
Organization Name:ALPHA PHYSICIANS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:DESANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-250-7377
Mailing Address - Street 1:30808 ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:GIBRALTAR
Mailing Address - State:MI
Mailing Address - Zip Code:48173-9547
Mailing Address - Country:US
Mailing Address - Phone:734-250-7377
Mailing Address - Fax:734-284-6889
Practice Address - Street 1:30808 ISLAND DR
Practice Address - Street 2:
Practice Address - City:GIBRALTAR
Practice Address - State:MI
Practice Address - Zip Code:48173-9547
Practice Address - Country:US
Practice Address - Phone:734-250-7377
Practice Address - Fax:734-284-6889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOP53240OtherPTAN