# KODIAK ISLAND MEDICAL ASSOCIATES LLC

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

## Provider details

- **NPI number:** 1770529794
- **Authorized official:** DR. MARK E WITHROW (OWNER)
- **Authorized official phone:** (907) 486-6065

## Contact information

- **Practice address:** 1818 E REZANOF DR, KODIAK, AK 99615
- **Practice address phone:** (907) 486-6065
- **Practice address fax:** (907) 486-2248
- **Mailing address:** PO BOX 8689, KODIAK, AK 99615-8689
- **Mailing address phone:** (907) 486-6065
- **Mailing address fax:** (907) 486-2248

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/20/2006
- **Last updated:** 12/06/2017