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General NPI Number Information
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NPI Number | 1366580912
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Entity Type | Organization
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Legal Business Name | ALASKA INTERNAL MEDICINE & PEDIATRICS LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 4048 LAUREL ST STE 306
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City | ANCHORAGE
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State | AK
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Zip | 99508-5391
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Country | US
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Telephone | 907-770-7800
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Fax | 907-929-4660
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Provider Business Mailing Address
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Address Line | 4048 LAUREL ST STE 306
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City | ANCHORAGE
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State | AK
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Zip | 99508-5391
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Country | US
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Telephone | 907-770-7800
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Fax | 907-929-4660
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHELE L O'FALLON
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Credential | M.D.
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Telephone | 907-770-7800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | AA3566
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 2342
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License Number State | AK
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