Provider Demographics
NPI:1366443871
Name:SENTA, MICHAEL R (MD, FACS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:R
Last Name:SENTA
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Gender:M
Credentials:MD, FACS
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Mailing Address - Street 1:2490 S WOODWORTH LOOP
Mailing Address - Street 2:SUITE 450
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-7405
Mailing Address - Country:US
Mailing Address - Phone:907-745-8100
Mailing Address - Fax:907-746-2655
Practice Address - Street 1:2490 S WOODWORTH LOOP
Practice Address - Street 2:SUITE 450
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-7405
Practice Address - Country:US
Practice Address - Phone:907-745-8100
Practice Address - Fax:907-746-2655
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2007-12-18
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Provider Licenses
StateLicense IDTaxonomies
AK1660208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD1660Medicaid
AKK00WCJQLBMedicare PIN
AKMD1660Medicaid