Provider Demographics
NPI:1457431785
Name:BOESENBERG, KARL ALBERT (DPM)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:ALBERT
Last Name:BOESENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 DEBARR RD
Mailing Address - Street 2:SUITE C-315
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-2953
Mailing Address - Country:US
Mailing Address - Phone:907-562-4958
Mailing Address - Fax:907-562-5195
Practice Address - Street 1:2741 DEBARR RD
Practice Address - Street 2:SUITE C-315
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2953
Practice Address - Country:US
Practice Address - Phone:907-562-4958
Practice Address - Fax:907-562-5195
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK2164213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKPD2164Medicaid
AKPD2164Medicaid
AK00WCNJXDMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE NUMBE