Basic Information
| Provider Information | |||||||||
| NPI: | 1043347248 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 127 S. SAN VICENTE BLVD. | ||||||||
| Address2: | SUITE A6600 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104234420 | ||||||||
| FaxNumber: | 3104230810 | ||||||||
| Practice Location | |||||||||
| Address1: | 127 S. SAN VICENTE BLVD. | ||||||||
| Address2: | SUITE A6600 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900485901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104234420 | ||||||||
| FaxNumber: | 3104230810 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2007 | ||||||||
| LastUpdateDate: | 11/05/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | G77195 | CA | Y | Allopathic & Osteopathic Physicians | Neurological Surgery | 2085R0202X | 2000-01051 | NC | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | G77195 | CA | N | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 207T00000X | 2000-01051 | NC | N | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8912651 | 05 | NC | MEDICAID |