Healthcare Provider Details

I. General information

NPI: 1669447595
Provider Name (Legal Business Name): MARY KLIX MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY M KOMANETSKY

II. Dates (important events)

Enumeration Date: 02/22/2006
Last Update Date: 09/19/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3851 PIPER STREET, STE 4340
ANCHORAGE AK
99508
US

IV. Provider business mailing address

3851 PIPER STREET, STE 4340
ANCHORAGE AK
99508
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number112773
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: