Provider Demographics
NPI:1548223191
Name:SARRIMANOLIS, NIKOLAS I (MD)
Entity Type:Individual
Prefix:DR
First Name:NIKOLAS
Middle Name:I
Last Name:SARRIMANOLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1867 AIRPORT WAY
Mailing Address - Street 2:STE 145 B
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701
Mailing Address - Country:US
Mailing Address - Phone:907-451-1174
Mailing Address - Fax:907-451-1173
Practice Address - Street 1:1867 AIRPORT WAY
Practice Address - Street 2:STE 145 B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-451-1174
Practice Address - Fax:907-451-1173
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4668207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD42851Medicaid
AK4668OtherAK STATE LICENSE
G21849Medicare UPIN
AKMD42851Medicaid