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Organization
KODIAK LIFE DIAGNOSTIC IMAGING, INC
Active
Organization
KODIAK LIFE DIAGNOSTIC IMAGING, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES DARRYL BISE DO (PRESIDENT)
(907) 512-9559
Entity
Organization
Contact information
Practice address
1915 E REZANOF DR, KODIAK, AK 99615-6602
(907) 512-9559
Mailing address
PO BOX 8790, KODIAK, AK 99615-8790
(907) 512-9559
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
106389
AK
Other
Enumeration date
10/13/2017
Last updated
10/13/2017
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