Provider Demographics
NPI:1912096769
Name:DUNKEL, ALEC JON (MD)
Entity Type:Individual
Prefix:
First Name:ALEC
Middle Name:JON
Last Name:DUNKEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:
Other - Last Name:DUNKEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17 EXCHANGE ST W
Mailing Address - Street 2:#500
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55102-1045
Mailing Address - Country:US
Mailing Address - Phone:651-232-4200
Mailing Address - Fax:651-232-8866
Practice Address - Street 1:17 EXCHANGE ST W
Practice Address - Street 2:#500
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102-1045
Practice Address - Country:US
Practice Address - Phone:651-232-4200
Practice Address - Fax:651-232-8866
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40549207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN40549OtherMEDICAL LICENSE
MN572324800Medicaid
1100053690347Medicare ID - Type Unspecified
G78931Medicare UPIN