Basic Information
| Provider Information | |||||||||
| NPI: | 1053818997 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WORKMAN | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | FRANKLIN | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9401 HOLY CROSS LN STE 112 | ||||||||
| Address2: | |||||||||
| City: | BREESE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622303510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185267271 | ||||||||
| FaxNumber: | 6175267313 | ||||||||
| Practice Location | |||||||||
| Address1: | 9401 HOLY CROSS LN STE 112 | ||||||||
| Address2: | |||||||||
| City: | BREESE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622303510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6185267271 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2018 | ||||||||
| LastUpdateDate: | 12/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 036157955 | IL | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | 5151012389 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.