Healthcare Provider Details

I. General information

NPI: 1679786966
Provider Name (Legal Business Name): HARRY KALMAKOFF II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 KANAKANAK RD
DILLINGAHM AK
99576-0130
US

IV. Provider business mailing address

P.O. BOX 130 MEDICAL STAFF DEPARTMENT
DILLINGHAM AK
99576-0130
US

V. Phone/Fax

Practice location:
  • Phone: 907-842-9218
  • Fax: 907-842-9250
Mailing address:
  • Phone: 907-842-9218
  • Fax: 907-842-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: