Provider Demographics
NPI:1205171329
Name:ISA, ABDULKARIM
Entity type:Individual
Prefix:
First Name:ABDULKARIM
Middle Name:
Last Name:ISA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W BENSON BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3860
Mailing Address - Country:US
Mailing Address - Phone:907-351-4763
Mailing Address - Fax:907-334-3058
Practice Address - Street 1:440 W BENSON BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3860
Practice Address - Country:US
Practice Address - Phone:907-351-4763
Practice Address - Fax:907-334-3058
Is Sole Proprietor?:No
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator