Alex S Blaivas, MD

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

4301406730 Issued in MI

Practice address

201 E Liberty St
Ste 23
Ann Arbor, MI 48104-2118

Phone

(734) 997-9729

Fax

(734) 997-9739

NPI assigned

Apr 26, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1326268954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 E HURON ST",
            "address_2": "APT 503",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481041573",
            "telephone_number": "734-769-1475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 E LIBERTY ST",
            "address_2": "STE 23",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481042118",
            "telephone_number": "734-997-9729",
            "fax_number": "734-997-9739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAIVAS",
        "first_name": "ALEX",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-26",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "MI",
            "license": "4301406730",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2617799",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "2608221962",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MI LICENSE",
            "identifier": "4301406730",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• John David Blaha, MD
• Ramona Lynn Blair, MS, LPC
• Christie Blais, LMSW
• Bailey A Blaisdell, M.A., SLP
• Kayla Blaise
• Eric Blake, MD
• Julie Ann Blake, CNM
• Terah Blakemore
• Collin A Blakita
• Traci Lynn Blancke, MSW, LMSW

• Psychiatry Physician in Ann Arbor, MI
• Providers in Ann Arbor, MI by specialty
• Psychiatry Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.