Provider Demographics
NPI:1831503440
Name:ANDRZEJ MACIEJEWSKI MD, INC
Entity type:Organization
Organization Name:ANDRZEJ MACIEJEWSKI MD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRZEJ
Authorized Official - Middle Name:RYSZARD
Authorized Official - Last Name:MACIEJEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:907-222-1714
Mailing Address - Street 1:3260 PROVIDENCE DR
Mailing Address - Street 2:SUITE 526
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4661
Mailing Address - Country:US
Mailing Address - Phone:907-222-1714
Mailing Address - Fax:907-222-1724
Practice Address - Street 1:3260 PROVIDENCE DR STE 523
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4608
Practice Address - Country:US
Practice Address - Phone:907-222-1714
Practice Address - Fax:907-222-1724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-12
Last Update Date:2017-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4655207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK1012171Medicaid
AKK151796Medicare PIN