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General NPI Number Information
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NPI Number | 1710664966
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Entity Type | Organization
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Legal Business Name | DENALI PRIMARY CARE
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Dates
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Enumeration Date | 06/29/2023
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Last Update Date | 03/01/2024
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Provider Practice Location Address
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Address Line | 1919 LATHROP ST STE 204
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City | FAIRBANKS
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State | AK
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Zip | 99701-5942
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Country | US
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Telephone | 907-687-6226
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81336
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City | FAIRBANKS
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State | AK
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Zip | 99708-1336
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Country | US
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Telephone | 907-687-6226
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | MANAL DARWISH SHIHADEH
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Credential | MD
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Telephone | 907-687-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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