Healthcare Provider Details

I. General information

NPI: 1992420145
Provider Name (Legal Business Name): AIDAN MOURIK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2022
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36TH MEDICAL GROUP UNIT 14010 BLDG. 26012 ANDERSEN AFB
APO AP
96543-4003
US

IV. Provider business mailing address

36TH MEDICAL GROUP UNIT 14010 BLDG. 26012 ANDERSEN AFB
APO AP
96543-4003
US

V. Phone/Fax

Practice location:
  • Phone: 671-366-3233
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number37095
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: