Provider Demographics
NPI:1144513060
Name:PAUL, ALEX S
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:S
Last Name:PAUL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1949 W 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1868
Mailing Address - Country:US
Mailing Address - Phone:248-543-3700
Mailing Address - Fax:248-543-4180
Practice Address - Street 1:1949 W 12 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1868
Practice Address - Country:US
Practice Address - Phone:248-543-3700
Practice Address - Fax:248-543-4180
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI12251034191744R1102X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty
No1744R1102XOther Service ProvidersSpecialistResearch StudyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1225103419OtherNPI