Healthcare Provider Details

I. General information

NPI: 1821030206
Provider Name (Legal Business Name): KATMAI ONCOLOGY GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PIPER STREET #U340
ANCHORAGE AK
99508-4627
US

IV. Provider business mailing address

PO BOX 74900
CHICAGO IL
60675-4900
US

V. Phone/Fax

Practice location:
  • Phone: 907-562-0321
  • Fax: 907-562-2683
Mailing address:
  • Phone: 602-441-9520
  • Fax: 907-562-2683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARIJA BAKRAC
Title or Position: CREDENTIALING
Credential:
Phone: 907-562-0321