Organization
INTEGRATED CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL T UNDERWOOD BBA (AGENT)
(907) 696-1654
Entity
Organization
Contact information
Practice address
540 E HJELLEN DRIVE, WASILLA, AK 99654
(907) 696-1654
(907) 696-3654
Mailing address
PO BOX 773313, EAGLE RIVER, AK 99577-3313
(907) 696-1654
(907) 696-3654
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
380
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1881735967
NPI
—
01
—
380
AK STATE LICENSE
AK
Enumeration date
12/07/2009
Last updated
12/07/2009
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