Basic Information
| Provider Information | |||||||||
| NPI: | 1144256017 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 515 22ND AVE | ||||||||
| Address2: | |||||||||
| City: | MONROE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535661569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8157131967 | ||||||||
| FaxNumber: | 8152272880 | ||||||||
| Practice Location | |||||||||
| Address1: | 515 22ND AVENUE | ||||||||
| Address2: | MONROE CLINIC | ||||||||
| City: | MONROE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535661569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083242222 | ||||||||
| FaxNumber: | 8152272880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 207R00000X | 36-111220 | IL | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | BA8945288 | 01 | DEA | OTHER | 0-308-016-2 | 01 | ECFMG | OTHER |