Healthcare Provider Details

I. General information

NPI: 1023076007
Provider Name (Legal Business Name): GARTH W LECHEMINANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3674 E MERIDIAN LOOP
WASILLA AK
99654-7272
US

IV. Provider business mailing address

PO BOX 876774
WASILLA AK
99687-6774
US

V. Phone/Fax

Practice location:
  • Phone: 907-373-8100
  • Fax:
Mailing address:
  • Phone: 907-745-8100
  • Fax: 907-746-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number5147
License Number StateAK

VII. Legacy identifiers

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

# 1
IdentifierMD5147
Identifier TypeMEDICAID
Identifier StateAK
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: