MEDICARE: KATMAI ONCOLOGY GROUP, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist
2	207RX0202X	Medical Oncology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821030206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATMAI ONCOLOGY GROUP, LLC

Provider Business Mailing Address
First Line	:	PO BOX 74900
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60675-4900
Country	:	US
Telephone Number	:	602-441-9520
Fax Number	:	907-562-2683

Provider Business Practice Location Address
First Line	:	3851 PIPER STREET
Second Line	:	#U340
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4627
Country	:	US
Telephone Number	:	907-562-0321
Fax Number	:	907-562-2683

Authorized Official
Title or Position	:	PARTNER
Name	:	SHANNON SMILEY
Credential	:	MD
Telephone Number	:	907-562-0321

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	12/24/2025

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