Provider Demographics
NPI:1063496313
Name:SVERDRUP, EILEEN KAREN (MD)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:KAREN
Last Name:SVERDRUP
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43977 STERLING HWY
Mailing Address - Street 2:STE G
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-8028
Mailing Address - Country:US
Mailing Address - Phone:907-262-7201
Mailing Address - Fax:907-260-5392
Practice Address - Street 1:43977 STERLING HWY
Practice Address - Street 2:STE G
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-8028
Practice Address - Country:US
Practice Address - Phone:907-262-7201
Practice Address - Fax:907-260-5392
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-30
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD00611Medicaid
AK150623Medicare ID - Type Unspecified
AKMD00611Medicaid