MEDICARE: NORTHERN NEUROLOGY CONSULTANTS, 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	207R00000X	Internal Medicine Physician	433242	AK

General Provider Information

NPI Number	:	1720080377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN NEUROLOGY CONSULTANTS, LLC.

Provider Business Mailing Address
First Line	:	PO BOX 241889
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99524-1889
Country	:	US
Telephone Number	:	907-563-1777
Fax Number	:	907-561-7464

Provider Business Practice Location Address
First Line	:	3650 LAKE OTIS PKWY
Second Line	:	SUITE 205
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-5207
Country	:	US
Telephone Number	:	907-563-1565
Fax Number	:	907-561-1541

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAYESH MAKIM
Credential	:	MD
Telephone Number	:	907-561-1565

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	08/22/2020

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