Provider Demographics
NPI:1669923280
Name:JOSEPH, ALEX K (MBBS, PA-C)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:K
Last Name:JOSEPH
Suffix:
Gender:M
Credentials:MBBS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9403 CLANCY DR
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-5118
Mailing Address - Country:US
Mailing Address - Phone:224-399-5393
Mailing Address - Fax:
Practice Address - Street 1:2000 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-1775
Practice Address - Country:US
Practice Address - Phone:630-463-6036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005999363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant