Organization
KODIAK ANESTHESIA PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW D. CHYNOWETH D.O. (MD)
(307) 473-8173
Entity
Organization
Contact information
Practice address
111 W 2ND ST, SUITE 415, CASPER, WY 82601-2454
(307) 237-5848
(307) 237-5848
Mailing address
4850 CHINOOK TRL, CASPER, WY 82604-5201
(307) 473-8173
Taxonomy
Speciality
Code
Description
License number
State
170100000X
Ph.D. Medical Genetics
7192A
WY
207L00000X
Anesthesiology Physician
Primary
—
—
Other
Enumeration date
09/22/2006
Last updated
10/19/2021
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