Basic Information
| Provider Information | |||||||||
| NPI: | 1669640504 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TODD D ALEXANDER MD SC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1235 N MULFORD RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611073879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153970077 | ||||||||
| FaxNumber: | 8153970016 | ||||||||
| Practice Location | |||||||||
| Address1: | 1235 N MULFORD RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ROCKFORD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 611073879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8153970077 | ||||||||
| FaxNumber: | 8153970016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2008 | ||||||||
| LastUpdateDate: | 02/21/2008 | ||||||||
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| AuthorizedOfficialLastName: | HAUSER | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8153970077 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 036087626 | IL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | DB6066 | 01 | IL | RAILROAD MEDICARE | OTHER | 10107489 | 01 | IL | BCBS ILLINOIS | OTHER |