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General NPI Number Information
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NPI Number | 1245267327
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Entity Type | Organization
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Legal Business Name | CENTER FOR WEIGHT LOSS SURGERY PLLC
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 34509 9TH AVE. SOUTH SUITE 103
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8707
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Country | US
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Telephone | 253-815-7774
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Fax | 253-815-7708
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Provider Business Mailing Address
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Address Line | 34509 9TH AVE. SOUTH SUITE 103
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City | FEDERAL WAY
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State | WA
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Zip | 98003-8707
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Country | US
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Telephone | 253-815-7774
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Fax | 253-815-7708
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Authorized Official
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Title or Position | PRESIDENT
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Name | MYUR S SRIKANTH
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Credential | M. D.
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Telephone | 253-815-7774
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD00033726
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License Number State | WA
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