Provider Demographics
NPI:1457543621
Name:SODIPE, ALEXANDER O (RN)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:O
Last Name:SODIPE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 E 75TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-1929
Mailing Address - Country:US
Mailing Address - Phone:773-488-2199
Mailing Address - Fax:773-675-5991
Practice Address - Street 1:732 E 75TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-1929
Practice Address - Country:US
Practice Address - Phone:773-488-2199
Practice Address - Fax:773-675-5991
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203.000934332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies