MEDICARE: SHADI G BADRIEH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	2003023196	MO
2	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	2003023196	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	662090	OTHER	HEALTHLINK
3	183140	OTHER	BCBS

General Provider Information

NPI Number	:	1447296280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADI G BADRIEH MD

Provider Business Mailing Address
First Line	:	PO BOX 3360
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-3360
Country	:	US
Telephone Number	:	425-525-3316
Fax Number	:

Provider Business Practice Location Address
First Line	:	12800 BOTHELL EVERETT HWY
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98208-6642
Country	:	US
Telephone Number	:	425-316-5440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	04/14/2021

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