Provider Demographics
NPI:1558467027
Name:ALEXIADES, MICHAEL M (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:M
Last Name:ALEXIADES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:523 E 72ND ST FL 7
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4099
Mailing Address - Country:US
Mailing Address - Phone:212-774-7557
Mailing Address - Fax:212-774-7525
Practice Address - Street 1:523 E 72ND ST FL 7
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4099
Practice Address - Country:US
Practice Address - Phone:212-774-7557
Practice Address - Fax:212-774-7525
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY158827207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYD91798Medicare UPIN
NY17F211Medicare ID - Type Unspecified