Provider Demographics
NPI:1689723116
Name:POMO, MICHAEL LEON (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEON
Last Name:POMO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 PIPER STREET
Mailing Address - Street 2:SUITE T3-162
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508
Mailing Address - Country:US
Mailing Address - Phone:907-258-1258
Mailing Address - Fax:
Practice Address - Street 1:3841 PIPER STREET
Practice Address - Street 2:SUITE T3-162
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-0000
Practice Address - Country:US
Practice Address - Phone:907-258-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3451207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKA41129Medicare UPIN