Provider Demographics
NPI:1023513553
Name:CANIGLIA, ALEXANDER JOSEPH (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:JOSEPH
Last Name:CANIGLIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9290 E THOMPSON PEAK PKWY UNIT 489
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-4519
Mailing Address - Country:US
Mailing Address - Phone:602-377-2504
Mailing Address - Fax:
Practice Address - Street 1:170 W 106TH ST
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46290-1004
Practice Address - Country:US
Practice Address - Phone:317-575-0330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01089718A207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01089718AOtherINDIANA LICENSE NUMBER
IN01089718BOtherIN-CSR