Provider Demographics
NPI:1912989203
Name:USPENSKY, ALEX (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:USPENSKY
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 1:5851 DULUTH STREET
Mailing Address - Street 2:SUITE 311
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55422
Mailing Address - Country:US
Mailing Address - Phone:763-541-9806
Mailing Address - Fax:763-541-9821
Practice Address - Street 1:5851 DULUTH STREET
Practice Address - Street 2:SUITE 311
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55422
Practice Address - Country:US
Practice Address - Phone:763-541-9806
Practice Address - Fax:763-541-9821
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN280602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1553355OtherMEDICA
MN097880900Medicaid
MN57822USOtherBCBS OF MN
MN260001800Medicare ID - Type Unspecified
MN097880900Medicaid