Healthcare Provider Details

I. General information

NPI: 1588750004
Provider Name (Legal Business Name): ELIZABETH KAREN VIG MD MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY VAPSHCS S182 ETHICS
SEATTLE WA
98108
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY VAPSHCS S182 ETHICS
SEATTLE WA
98108
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2308
  • Fax: 206-277-4405
Mailing address:
  • Phone: 206-764-2308
  • Fax: 206-277-4405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberMD00034003
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: