NORTH STAR PLASTIC SURGERY LLC NPI 1417653569

NPI Information

  • NPI: 1417653569
  • Provider Name: NORTH STAR PLASTIC SURGERY LLC
  • Classification: Surgery - 2086S0122X
  • Specialization: Plastic and Reconstructive Surgery
  • Entity Type: Organization
  • Address: 1919 LATHROP ST STE 205
    FAIRBANKS, AK
    ZIP 99701
  • Phone: (907) 416-5611

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NPI Details

NORTH STAR PLASTIC SURGERY LLC is a plastic and reconstructive surgery surgery in Fairbanks, AK. The provider is a surgeon who specializes in plastic and reconstructive surgery. NORTH STAR PLASTIC SURGERY LLC NPI is 1417653569. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

1919 LATHROP ST STE 205
FAIRBANKS, AK
ZIP 99701-942
Phone: (907) 416-5611

The provider's authorized official is Erick Martell .
The authorized official title is Owner and has the following contact phone number (305) 761-1934.

The enumeration date for this NPI number is 1/31/2023 and was last updated on 9/13/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12086S0122XSurgeryPlastic and Reconstructive SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11720992MEDICAIDALASKA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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