MEDICARE: DR. TAKLA E GARDEY 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	207Q00000X	Family Medicine Physician	35311	WA

General Provider Information

NPI Number	:	1467529800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TAKLA E GARDEY MD

Provider Business Mailing Address
First Line	:	6300 9TH AVE NE
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98115
Country	:	US
Telephone Number	:	206-522-5646
Fax Number	:	206-524-5054

Provider Business Practice Location Address
First Line	:	6300 9TH AVE NE
Second Line	:	SUITE 200
City	:	SEATTLE
State	:	WA
Zip	:	98115-8515
Country	:	US
Telephone Number	:	206-522-5646
Fax Number	:	206-524-5054

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	10/10/2013

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