Individual
ANTHONY ALEXANDER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3709 BROADWAY STE 12, GARY, IN 46409-1501
(219) 239-1961
Mailing address
3709 BROADWAY STE 12, GARY, IN 46409-1501
(219) 239-1961
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
8945433419
IN
Other
Enumeration date
06/26/2024
Last updated
06/26/2024
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