Provider Demographics
NPI:1306952569
Name:WASILE, OLGA IRIS (MD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:IRIS
Last Name:WASILE
Suffix:
Gender:F
Credentials:MD
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 671249
Mailing Address - Street 2:
Mailing Address - City:CHUGIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99567-1249
Mailing Address - Country:US
Mailing Address - Phone:907-688-0901
Mailing Address - Fax:907-688-0830
Practice Address - Street 1:20905 EASTSIDE DRIVE #1
Practice Address - Street 2:
Practice Address - City:CHUGIAK
Practice Address - State:AK
Practice Address - Zip Code:99567-1249
Practice Address - Country:US
Practice Address - Phone:907-688-0901
Practice Address - Fax:907-688-0830
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK4987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5767Medicaid
AKH79423Medicare UPIN
AK152454Medicare ID - Type UnspecifiedMEDICARE