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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