Provider Demographics
NPI:1710375209
Name:KILANOWSKI, DANIEL
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:KILANOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7362 W PARKS HWY # 204
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99623-9300
Mailing Address - Country:US
Mailing Address - Phone:907-315-7463
Mailing Address - Fax:907-357-7428
Practice Address - Street 1:5900 W LOCKSLEY LOOP
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99623-0837
Practice Address - Country:US
Practice Address - Phone:907-315-7463
Practice Address - Fax:907-357-7428
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-06
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator