Provider Demographics
NPI:1558319434
Name:EMILI, STEFANO (MD)
Entity Type:Individual
Prefix:DR
First Name:STEFANO
Middle Name:
Last Name:EMILI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3260 PROVIDENCE DR STE 528
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4608
Mailing Address - Country:US
Mailing Address - Phone:907-770-7213
Mailing Address - Fax:907-770-7214
Practice Address - Street 1:3260 PROVIDENCE DR STE 528
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-770-7213
Practice Address - Fax:907-770-7214
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3815207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG902Medicaid
AKMDG902Medicaid