Individual
ALEJANDRO MIKELONIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
610 N MICHIGAN ST STE 306, SOUTH BEND, IN 46601-1079
(574) 647-6500
(574) 647-6518
Mailing address
710 N NILES AVE, SOUTH BEND, IN 46617-1924
(574) 647-1610
(574) 237-6069
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
10002386A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
236040257
MEDICARE PTAN
IN
05
—
300008855
—
IN
01
—
M59677010
MEDICARE PTAN
IN
Enumeration date
11/20/2017
Last updated
12/21/2017
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