# ARCTIC PHYSICAL MEDICINE WASILLA

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

## Provider details

- **NPI number:** 1790184646
- **Authorized official:** KYLE T BERGQUIST (OWNER)
- **Authorized official phone:** (206) 713-4721

## Contact information

- **Practice address:** 1830 E PARKS HWY STE A120, WASILLA, AK 99654-7380
- **Practice address phone:** (206) 713-4721
- **Mailing address:** 1830 E PARKS HWY STE A120, WASILLA, AK 99654-7380

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 1305 | AK | Yes |

## Other

- **Enumeration date:** 08/16/2014
- **Last updated:** 08/16/2014