Provider Demographics
NPI:1740704766
Name:BIKOWSKI, ALEX F
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:F
Last Name:BIKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 E CEDAR ST., STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2057
Mailing Address - Country:US
Mailing Address - Phone:574-335-8731
Mailing Address - Fax:574-335-0741
Practice Address - Street 1:234 CHAPIN ST STE I
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-2571
Practice Address - Country:US
Practice Address - Phone:574-335-8250
Practice Address - Fax:574-335-0788
Is Sole Proprietor?:No
Enumeration Date:2017-08-01
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28205703A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100382210DMedicaid