1235134917 NPI number — DR. WINSTON LOUIS ALEXIS M.D.

Table of content: DR. WINSTON LOUIS ALEXIS M.D. (NPI 1235134917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235134917 NPI number — DR. WINSTON LOUIS ALEXIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALEXIS
Provider First Name:
WINSTON
Provider Middle Name:
LOUIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235134917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
150 NW 70TH AVE STE 7
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANTATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33317-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-452-4377
Provider Business Mailing Address Fax Number:
954-452-1022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5975 W. SUNRISE BLVD.
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SUNRISE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-791-4311
Provider Business Practice Location Address Fax Number:
954-791-2729
Provider Enumeration Date:
06/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  ME36984 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 269097700 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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