Basic Information
| Provider Information | |||||||||
| NPI: | 1053574160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | HOLT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 S. 4TH STREET #201 | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 404222091 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025843200 | ||||||||
| FaxNumber: | 5025843333 | ||||||||
| Practice Location | |||||||||
| Address1: | 305 S. 4TH STREET #201 | ||||||||
| Address2: | |||||||||
| City: | DANVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025843200 | ||||||||
| FaxNumber: | 5025843333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2008 | ||||||||
| LastUpdateDate: | 08/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | 48452 | KY | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 207RA0002X | 48452 | KY | Y |
ID Information
| ID | Type | State | Issuer | Description | 7100362960 | 05 | KY | MEDICAID | 0141248 | 05 | OH | MEDICAID | 201320800 | 05 | IN | MEDICAID |