MEDICARE: MEDICAL GROUP OF ALASKA

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	208D00000X	General Practice Physician	1019166	AK

General Provider Information

NPI Number	:	1750730594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL GROUP OF ALASKA

Provider Business Mailing Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 207
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-357-7710
Fax Number	:	907-357-7720

Provider Business Practice Location Address
First Line	:	3190 E MERIDIAN PARK LOOP STE 207
Second Line	:
City	:	WASILLA
State	:	AK
Zip	:	99654-7422
Country	:	US
Telephone Number	:	907-357-7710
Fax Number	:	907-357-7720

Authorized Official
Title or Position	:	CEO
Name	:	KIRA GALLIHER
Credential	:
Telephone Number	:	907-631-4550

Provider Enumeration Date	:	06/10/2016
Last Update Date	:	11/15/2023

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