| Doctor Name: | ALEXANDRA RUSETZKE |
| NPI Number: | 1003202623 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 5601007303 |
| Business Practice Address: | 601 John St Suite M-302 Kalamazoo, MI - 490075341 |
| Business Phone Number: | 2693414890 |
| Business Fax Number: | 2693414889 |
| Mailing Address: | 601 John St, Suite M302 KALAMAZOO |
| State: | MI |
| Postal Code: | 490075341 |
| Phone Number: | 2693414890 |
| Fax Number: | 2693414889 |
| NPI Enumeration Date: | 04/09/2015 |
| NPI Last Update Date: | 05/20/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 5601007303 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |