Provider Demographics
NPI:1356790034
Name:MORNINGSTAR, ALEXA (DO)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:
Last Name:MORNINGSTAR
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52500 FIR RD
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-8579
Mailing Address - Country:US
Mailing Address - Phone:574-271-0700
Mailing Address - Fax:574-273-5648
Practice Address - Street 1:52500 FIR RD
Practice Address - Street 2:
Practice Address - City:GRANGER
Practice Address - State:IN
Practice Address - Zip Code:46530-8579
Practice Address - Country:US
Practice Address - Phone:574-271-0700
Practice Address - Fax:574-273-5648
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02005728A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11018847AOtherIN MEDICAL LICENSE