Provider Demographics
NPI:1649601279
Name:KATMAI PROFESSIONAL SERVICES GROUP, LLC
Entity Type:Organization
Organization Name:KATMAI PROFESSIONAL SERVICES GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEFLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:907-570-2899
Mailing Address - Street 1:1120 HUFFMAN RD
Mailing Address - Street 2:SUITE 24-691
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3516
Mailing Address - Country:US
Mailing Address - Phone:907-830-9506
Mailing Address - Fax:
Practice Address - Street 1:1120 HUFFMAN RD
Practice Address - Street 2:SUITE 24-691
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3516
Practice Address - Country:US
Practice Address - Phone:907-830-9506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-08
Last Update Date:2022-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK997150207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty