Healthcare Provider Details

I. General information

NPI: 1447754684
Provider Name (Legal Business Name): MANISHA THUPARANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 02/24/2022
Certification Date: 02/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 SW ALASKA ST STE B
SEATTLE WA
98116-4527
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-320-3399
  • Fax: 206-320-5506
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61107031
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: