Provider Demographics
NPI:1134133499
Name:ALASKA HEART CLINIC, INC
Entity Type:Organization
Organization Name:ALASKA HEART CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:KADADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-357-9444
Mailing Address - Street 1:PO BOX 872178
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99687-2178
Mailing Address - Country:US
Mailing Address - Phone:907-373-1565
Mailing Address - Fax:
Practice Address - Street 1:950 BOGARD RD
Practice Address - Street 2:SUITE 207
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7105
Practice Address - Country:US
Practice Address - Phone:907-357-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3926207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty