Healthcare Provider Details

I. General information

NPI: 1639138944
Provider Name (Legal Business Name): SANTANU BISWAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2006
Last Update Date: 02/10/2020
Certification Date: 02/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 17TH AVE STE 680
SEATTLE WA
98122-5795
US

IV. Provider business mailing address

PO BOX 25608
SALT LAKE CITY UT
84125-0608
US

V. Phone/Fax

Practice location:
  • Phone: 206-861-8550
  • Fax: 206-861-8551
Mailing address:
  • Phone: 206-320-4476
  • Fax: 206-568-7043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60985353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: