MEDICARE: ALASKA INTERNAL MEDICINE & PEDIATRICS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	AA3566	AK
2	174400000X	Specialist	2342	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1902877251	OTHER	AK	O'FALLON (NPI)
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1710958061	OTHER	AK	MONTANO (NPI)

General Provider Information

NPI Number	:	1366580912
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALASKA INTERNAL MEDICINE & PEDIATRICS LLC

Provider Business Mailing Address
First Line	:	4048 LAUREL ST STE 306
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5391
Country	:	US
Telephone Number	:	907-770-7800
Fax Number	:	907-929-4660

Provider Business Practice Location Address
First Line	:	4048 LAUREL ST STE 306
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5391
Country	:	US
Telephone Number	:	907-770-7800
Fax Number	:	907-929-4660

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MICHELE L O'FALLON
Credential	:	M.D.
Telephone Number	:	907-770-7800

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	06/26/2008

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Directions to “ALASKA INTERNAL MEDICINE & PEDIATRICS LLC ” Practice Location

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