Healthcare Provider Details

I. General information

NPI: 1225041791
Provider Name (Legal Business Name): SHAILENDER BHATIA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 EASTLAKE AVE E MAILSTOP G4-830
SEATTLE WA
98109-4405
US

IV. Provider business mailing address

PO BOX 50095
SEATTLE WA
98145-5095
US

V. Phone/Fax

Practice location:
  • Phone: 206-288-2015
  • Fax: 206-288-6210
Mailing address:
  • Phone: 206-520-5307
  • Fax: 206-520-5620

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberMD00044104
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: