Healthcare Provider Details

I. General information

NPI: 1609834258
Provider Name (Legal Business Name): CONSTANTINE W PALASKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 MADISON ST STE 1410
SEATTLE WA
98104-3555
US

IV. Provider business mailing address

1570 WEST ARMORY WAY SUITE 101, PMB#105
SEATTLE WA
98119
US

V. Phone/Fax

Practice location:
  • Phone: 206-486-8088
  • Fax: 206-971-1656
Mailing address:
  • Phone: 206-486-8088
  • Fax: 206-971-1656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00022586
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License NumberMD00022586
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: