Healthcare Provider Details

I. General information

NPI: 1467694620
Provider Name (Legal Business Name): POLAR PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 12/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 W. TUDOR RD
ANCHORAGE AK
99503
US

IV. Provider business mailing address

603 W. TUDOR RD
ANCHORAGE AK
99503
US

V. Phone/Fax

Practice location:
  • Phone: 907-522-5437
  • Fax: 907-522-5435
Mailing address:
  • Phone: 907-522-5437
  • Fax: 907-522-5435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number6196
License Number StateAK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1020541
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name: DR. MONIQUE L. CHILD
Title or Position: PEDIATRICIAN OWNER
Credential: MD
Phone: 907-522-5437