Healthcare Provider Details

I. General information

NPI: 1265028484
Provider Name (Legal Business Name): DK ANESTHESIA SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2020
Last Update Date: 12/13/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 SADLER WAY STE 202
FAIRBANKS AK
99701-3175
US

IV. Provider business mailing address

1275 SADLER WAY STE 202
FAIRBANKS AK
99701-3175
US

V. Phone/Fax

Practice location:
  • Phone: 907-452-4101
  • Fax: 907-452-4102
Mailing address:
  • Phone: 907-452-4101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DIANA KOVACICH
Title or Position: ORGANIZER
Credential: MD
Phone: 907-687-0745