Provider Demographics
NPI:1700012598
Name:BAJMOCZI, MILAN (MD)
Entity Type:Individual
Prefix:
First Name:MILAN
Middle Name:
Last Name:BAJMOCZI
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 1:1122 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-4744
Mailing Address - Country:US
Mailing Address - Phone:907-452-8181
Mailing Address - Fax:
Practice Address - Street 1:1650 COWLES STREET
Practice Address - Street 2:MEDICAL STAFF SVCS
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701
Practice Address - Country:US
Practice Address - Phone:907-452-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKMEDS80332086S0129X
MA2404212086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1614811Medicaid