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General NPI Number Information
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NPI Number | 1144362005
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Entity Type | Organization
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Legal Business Name | GREENLAKE PLASTIC SURGERY, PLLC
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 11/21/2008
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Provider Practice Location Address
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Address Line | 1221 MADISON ST SUITE #1520
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City | SEATTLE
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State | WA
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Zip | 98104-3588
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Country | US
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Telephone | 206-292-6226
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Fax |
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Provider Business Mailing Address
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Address Line | 1037 NE 65TH ST # 336
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City | SEATTLE
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State | WA
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Zip | 98115-6655
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Country | US
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Telephone | 206-292-6226
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CATHERINE ELIZABETH CHATAL
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Credential | M.D.
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Telephone | 206-292-6226
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD00037134
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License Number State | WA
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