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Organization
ARCTIC PHYSICAL MEDICINE WASILLA
Active
Organization
ARCTIC PHYSICAL MEDICINE WASILLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYLE T BERGQUIST (OWNER)
(206) 713-4721
Entity
Organization
Contact information
Practice address
1830 E PARKS HWY STE A120, WASILLA, AK 99654-7380
(206) 713-4721
Mailing address
1830 E PARKS HWY STE A120, WASILLA, AK 99654-7380
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
1305
AK
Other
Enumeration date
08/16/2014
Last updated
08/16/2014
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