Provider Demographics
NPI:1780844258
Name:ALASKA PODIATRY GROUP, LLC
Entity Type:Organization
Organization Name:ALASKA PODIATRY GROUP, LLC
Other - Org Name:ALASKA PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:RINDLISBACHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:907-561-2213
Mailing Address - Street 1:4048 LAUREL ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-5390
Mailing Address - Country:US
Mailing Address - Phone:907-561-2213
Mailing Address - Fax:907-646-2213
Practice Address - Street 1:4048 LAUREL ST STE 204
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5390
Practice Address - Country:US
Practice Address - Phone:907-561-2213
Practice Address - Fax:907-646-2213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-09
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK3430261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric