Provider Demographics
NPI:1144888686
Name:POLICH, ALEXA RAE (PA)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:RAE
Last Name:POLICH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8837 WOODBINE CT
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60487-8640
Mailing Address - Country:US
Mailing Address - Phone:708-253-7698
Mailing Address - Fax:
Practice Address - Street 1:8837 WOODBINE CT
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60487-8640
Practice Address - Country:US
Practice Address - Phone:708-253-7698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-30
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant