# KODIAK LIFE DIAGNOSTIC IMAGING, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083125355
- **Authorized official:** DR. JAMES DARRYL BISE DO (PRESIDENT)
- **Authorized official phone:** (907) 512-9559

## Contact information

- **Practice address:** 1915 E REZANOF DR, KODIAK, AK 99615-6602
- **Practice address phone:** (907) 512-9559
- **Mailing address:** PO BOX 8790, KODIAK, AK 99615-8790
- **Mailing address phone:** (907) 512-9559

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | 106389 | AK | Yes |

## Other

- **Enumeration date:** 10/13/2017
- **Last updated:** 10/13/2017