Healthcare Provider Details

I. General information

NPI: 1669643896
Provider Name (Legal Business Name): ADONAI DIABETES AND ENDOCRINOLOGY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2008
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3331 E MERIDIAN PARK LOOP
WASILLA AK
99654-7299
US

IV. Provider business mailing address

3331 E MERIDIAN PARK LOOP
WASILLA AK
99654-7299
US

V. Phone/Fax

Practice location:
  • Phone: 907-357-8006
  • Fax:
Mailing address:
  • Phone: 907-357-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4646
License Number StateAK

VII. Legacy identifiers

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

VIII. Authorized Official

Name: SAMUEL ABBATE
Title or Position: PHYSICIAN
Credential: MD
Phone: 907-357-2332