Provider Demographics
NPI:1720080377
Name:NORTHERN NEUROLOGY CONSULTANTS, LLC.
Entity Type:Organization
Organization Name:NORTHERN NEUROLOGY CONSULTANTS, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-561-1565
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:907-563-1777
Mailing Address - Fax:907-561-7464
Practice Address - Street 1:3650 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5207
Practice Address - Country:US
Practice Address - Phone:907-563-1565
Practice Address - Fax:907-561-1541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK433242207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK160108Medicare ID - Type UnspecifiedNORIDIAN MEDICARE