Provider Demographics
NPI:1821030206
Name:KATMAI ONCOLOGY GROUP, LLC
Entity Type:Organization
Organization Name:KATMAI ONCOLOGY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:MARIJA
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKRAC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-562-0321
Mailing Address - Street 1:PO BOX 74900
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-4900
Mailing Address - Country:US
Mailing Address - Phone:602-441-9520
Mailing Address - Fax:907-562-2683
Practice Address - Street 1:3851 PIPER STREET
Practice Address - Street 2:#U340
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4627
Practice Address - Country:US
Practice Address - Phone:907-562-0321
Practice Address - Fax:907-562-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMDG5261Medicaid
AKK152928Medicare UPIN