Unknown Individual – Family Medicine Physician, NPI 1750307740

Unknown Individual is a healthcare provider. based in Kodiak, Alaska. specializing in Family Medicine Physician. They hold a License No. 6858 (AK). The NPI Number for Unknown Individual is 1750307740

Main info

Organization
Inactive
43 Years Of Experience
Accepts Medicare Assignment
Name
Unknown Individual
NPI
1750307740
Phone
(907) 486-3781
Address
1915 E REZANOF DR
Deactivation Date
5 March 2026

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7015235555
Graduation Year
1983 (43 years ago)
PAC ID
0840395869
Group Practice PAC ID
3173512704
Professional Enrollment ID
I20091006000154

Contacts

Secure Messaging
gculver237875@ak.providencedirect.org
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness85
Years active:0State licenses:1Other namesUpdated within 12 months

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Provider Addresses for Unknown Individual

  • East Rezanof Drive, Kodiak, Kodiak Island, Alaska, 99615, United States

    KODIAK, AK 996156602

    Phone: (907) 486-3781

    Fax: (907) 486-9586

    Type: Location

  • 615 6th St SE

    Stanley, ND 587844444

    Phone: (701) 628-2505

    Type: Location

  • 3706, Northeast Maywood Place, Maywood Park, Portland, Metro, Multnomah County, Oregon, 97220, United States

    PORTLAND, OR 972083706

    Phone: (866) 907-1068

    Fax: (425) 917-9141

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 99615)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 3173512704View full group profile
NameSpecialtyState
Emergency Medicine, Family Practice, Internal MedicineMI
-ND
-MN
Nurse PractitionerND
Nurse PractitionerND
Internal MedicineND
Nurse PractitionerND
Physician AssistantSD
General Surgery, Emergency Medicine, Emergency MedicineND

Reviews

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Frequently asked questions

How do I look up Unknown Individual by NPI?
Use NPI 1750307740 when you need to reference Unknown Individual in forms, claims, or directories.
Why would Unknown Individual's listing show inactive?
Inactive in NPPES means the identifier is not currently active in that dataset.
What does Unknown Individual treat or focus on?
Patients typically see Unknown Individual under the specialty Family Medicine Physician. Clinical services aligned with this taxonomy classification.
What location metadata exists for Unknown Individual?
The page summarizes Kodiak, Alaska for Unknown Individual; expand the address list for detail.
Does Medicare enrollment show here?
Medicare enrollment screens are separate from the basic NPI extract shown here.

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