Provider Demographics
NPI:1417653569
Name:NORTH STAR PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:NORTH STAR PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-761-1934
Mailing Address - Street 1:1919 LATHROP ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-5937
Mailing Address - Country:US
Mailing Address - Phone:907-459-3586
Mailing Address - Fax:907-374-7770
Practice Address - Street 1:1919 LATHROP ST STE 205
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-5942
Practice Address - Country:US
Practice Address - Phone:907-416-5611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-31
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1720992Medicaid