Healthcare Provider Details

I. General information

NPI: 1629011218
Provider Name (Legal Business Name): MICHAEL KIRWAN MRAZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 B ST SUITE 200
ANCHORAGE AK
99503-5925
US

IV. Provider business mailing address

4300 B ST SUITE 200
ANCHORAGE AK
99503-5925
US

V. Phone/Fax

Practice location:
  • Phone: 907-375-3355
  • Fax: 907-375-3351
Mailing address:
  • Phone: 907-375-3355
  • Fax: 907-375-3351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4839
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number4839
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: