Basic Information
| Provider Information | |||||||||
| NPI: | 1316326515 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | ALEKSEYENKO | ||||||||
| FirstName: | ALEKSEY | ||||||||
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| Mailing Information | |||||||||
| Address1: | MHPG PRIMARY CARE @ TRADITION HEALTH PARK II | ||||||||
| Address2: | 10080 SW INNOVATION WAY SUITE 201 | ||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723443811 | ||||||||
| FaxNumber: | 7723443890 | ||||||||
| Practice Location | |||||||||
| Address1: | MHPG PRIMARY CARE @ TRADITION HEALTH PARK II | ||||||||
| Address2: | 10080 SW INNOVATION WAY SUITE 201 | ||||||||
| City: | PORT ST LUCIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34987 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7723443811 | ||||||||
| FaxNumber: | 7723443890 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2015 | ||||||||
| LastUpdateDate: | 10/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | OS15148 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
No ID Information.