Provider Demographics
NPI:1306345657
Name:ESMAILKA, ELLIOTT GEORGE (CHA II)
Entity type:Individual
Prefix:
First Name:ELLIOTT
Middle Name:GEORGE
Last Name:ESMAILKA
Suffix:
Gender:M
Credentials:CHA II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21037
Mailing Address - Street 2:
Mailing Address - City:ANAKTUVUK PASS
Mailing Address - State:AK
Mailing Address - Zip Code:99721-0037
Mailing Address - Country:US
Mailing Address - Phone:907-987-6223
Mailing Address - Fax:
Practice Address - Street 1:3051 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ANAKTUVUK PASS
Practice Address - State:AK
Practice Address - Zip Code:99721
Practice Address - Country:US
Practice Address - Phone:907-661-3914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker