Provider Demographics
NPI:1770525776
Name:SPITZER, ALEXANDER ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:ROBERT
Last Name:SPITZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2005
Mailing Address - Street 2:
Mailing Address - City:MACKINAC ISLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49757-2005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8350 CEDAR CT
Practice Address - Street 2:
Practice Address - City:MACKINAC ISLAND
Practice Address - State:MI
Practice Address - Zip Code:49757
Practice Address - Country:US
Practice Address - Phone:906-847-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-1240282084N0400X
WI628792084N0400X
MN630812084N0400X
MI0508742084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIA79012Medicare UPIN