Basic Information
| Provider Information | |||||||||
| NPI: | 1275896425 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LAY | ||||||||
| FirstName: | ALEXANDER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 25 MICHIGAN ST NE | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163913245 | ||||||||
| FaxNumber: | 6163913130 | ||||||||
| Practice Location | |||||||||
| Address1: | 25 MICHIGAN ST NE | ||||||||
| Address2: | SUITE 2200 | ||||||||
| City: | GRAND RAPIDS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 495032515 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6163913245 | ||||||||
| FaxNumber: | 6163913130 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 06/22/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4301101257 | MI | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.