Healthcare Provider Details

I. General information

NPI: 1366580912
Provider Name (Legal Business Name): ALASKA INTERNAL MEDICINE & PEDIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4048 LAUREL ST STE 306
ANCHORAGE AK
99508-5391
US

IV. Provider business mailing address

4048 LAUREL ST STE 306
ANCHORAGE AK
99508-5391
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-7800
  • Fax: 907-929-4660
Mailing address:
  • Phone: 907-770-7800
  • Fax: 907-929-4660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberAA3566
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2342
License Number StateAK

VIII. Authorized Official

Name: DR. MICHELE L O'FALLON
Title or Position: OWNER
Credential: M.D.
Phone: 907-770-7800