Provider Demographics
NPI:1609434497
Name:CREED MAMIKUNIAN, MD
Entity Type:Organization
Organization Name:CREED MAMIKUNIAN, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CREED
Authorized Official - Middle Name:
Authorized Official - Last Name:MAMIKUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-562-1860
Mailing Address - Street 1:2401 E 42ND AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5228
Mailing Address - Country:US
Mailing Address - Phone:907-562-1860
Mailing Address - Fax:
Practice Address - Street 1:2401 E 42ND AVE STE 206
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5228
Practice Address - Country:US
Practice Address - Phone:907-562-1860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CREED MAMIKUNIAN, MD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD2517Medicaid