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Contact Information

MEDICAL GROUP OF ALASKA
3190 E MERDIAN PARK LOOP
SUITE 207
WASILLA, AK99654
 Phone: 907-373-9460
 Fax: 907-373-9461
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Pain Medicine

208VP0000X 72 Physician/Pain Management
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
Indicates primary specialty

NPI Profile & details for MEDICAL GROUP OF ALASKA · (Female)

NPI # 1174882971
Status Active
Credentials
Entity Individual
Enumeration date 05/14/2012
Last updated 05/24/2022 - About 4 years ago
Sole proprietor 1 Not specified
Identifiers
  • AK License # 1070929
  • AK License # 949810
  • AK Medicaid 1658871
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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