Healthcare Provider Details

I. General information

NPI: 1114548351
Provider Name (Legal Business Name): ALASKA FACIAL PLASTIC SURGERY & ENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2020
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3719 E MERIDIAN LOOP STE E
WASILLA AK
99654-7273
US

IV. Provider business mailing address

PO BOX 75045
CHICAGO IL
60675-5045
US

V. Phone/Fax

Practice location:
  • Phone: 907-522-3006
  • Fax:
Mailing address:
  • Phone: 907-600-0030
  • Fax: 907-206-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINA MAGILL
Title or Position: PRESIDENT
Credential: MD
Phone: 314-422-9716