Organization
KODIAK ISLAND MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK E WITHROW (OWNER)
(907) 486-6065
Entity
Organization
Contact information
Practice address
1818 E REZANOF DR, KODIAK, AK 99615
(907) 486-6065
(907) 486-2248
Mailing address
PO BOX 8689, KODIAK, AK 99615-8689
(907) 486-6065
(907) 486-2248
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Enumeration date
06/20/2006
Last updated
12/06/2017
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