1710234877 NPI number — MR. MICHAEL JAMES DEMOSKI EFDHA1

Table of content: MR. MICHAEL JAMES DEMOSKI EFDHA1 (NPI 1710234877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710234877 NPI number — MR. MICHAEL JAMES DEMOSKI EFDHA1

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMOSKI
Provider First Name:
MICHAEL
Provider Middle Name:
JAMES
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
EFDHA1
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710234877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
122 1ST AVE
Provider Second Line Business Mailing Address:
600
Provider Business Mailing Address City Name:
FAIRBANKS
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99701-4803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
907-452-8251
Provider Business Mailing Address Fax Number:
907-459-3837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
122 1ST AVE
Provider Second Line Business Practice Location Address:
600
Provider Business Practice Location Address City Name:
FAIRBANKS
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99701-4803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
907-452-8251
Provider Business Practice Location Address Fax Number:
907-459-3837
Provider Enumeration Date:
08/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 126800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com