Provider Demographics
NPI:1922897701
Name:SELIMOS, ALEXA KRYSTINE
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:KRYSTINE
Last Name:SELIMOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 W SHERIDAN PL
Mailing Address - Street 2:
Mailing Address - City:LAKE BLUFF
Mailing Address - State:IL
Mailing Address - Zip Code:60044-2326
Mailing Address - Country:US
Mailing Address - Phone:224-545-4923
Mailing Address - Fax:
Practice Address - Street 1:449 W SHERIDAN PL
Practice Address - Street 2:
Practice Address - City:LAKE BLUFF
Practice Address - State:IL
Practice Address - Zip Code:60044-2326
Practice Address - Country:US
Practice Address - Phone:224-545-4923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-06
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program