Provider Demographics
NPI:1831136456
Name:TODD, MICHAEL A (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:A
Last Name:TODD
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 241889
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99524-1889
Mailing Address - Country:US
Mailing Address - Phone:907-929-4263
Mailing Address - Fax:907-929-9526
Practice Address - Street 1:4100 LAKE OTIS PKWY STE 302
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5230
Practice Address - Country:US
Practice Address - Phone:907-929-4263
Practice Address - Fax:907-929-4267
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-01
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4168208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKF16585Medicare UPIN
AKMD2836Medicare ID - Type Unspecified
AKK152565Medicare ID - Type Unspecified