Individual provider Active NPI

Alexander M Mishel, DDS

  • Dentist
  • Indianapolis, IN
National Provider Identifier
1063669703
Registry record updated Aug 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12009382 Issued in IN
Practice address
6425 N Keystone Ave
Indianapolis, IN 46220-2158
Phone
(317) 255-2941
Fax
(317) 255-1656
NPI assigned
Aug 25, 2008
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 25, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 12009382 IN Primary

Addresses

Primary practice location

6425 N Keystone Ave
Indianapolis, IN 46220-2158

Mailing address

6425 N Keystone Ave
Indianapolis, IN 46220-2158
Phone (317) 255-2941

Other identifiers 1

IdentifierTypeStateIssuer
100218580AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161121000694 IN Order and Referring Only - DentistPractitioner - Dentist 6204115959

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
12009382INMDDentist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219622400000",
    "number": "1063669703",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6425 N KEYSTONE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462202158",
            "telephone_number": "317-255-2941",
            "fax_number": "317-255-1656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6425 N KEYSTONE AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462202158",
            "telephone_number": "317-255-2941",
            "fax_number": "317-255-1656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHEL",
        "first_name": "ALEXANDER",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-08-25",
        "last_updated": "2008-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12009382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100218580A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

Verify at the official NPI Registry.