Basic Information
| Provider Information | |||||||||
| NPI: | 1225514102 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SLOTA | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | ANTONI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2800 W GRAND BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887774167 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2800 W GRAND BLVD FL 6 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482022610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8887774167 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2018 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301116004 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0003X | 4351032286 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.