Healthcare Provider Details

I. General information

NPI: 1063496313
Provider Name (Legal Business Name): EILEEN KAREN SVERDRUP M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 11/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43977 STERLING HWY STE G
SOLDOTNA AK
99669-8028
US

IV. Provider business mailing address

43977 STERLING HWY STE G
SOLDOTNA AK
99669-8028
US

V. Phone/Fax

Practice location:
  • Phone: 907-262-7201
  • Fax: 907-260-5392
Mailing address:
  • Phone: 907-262-7201
  • Fax: 907-260-5392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2784
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: