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General NPI Number Information
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NPI Number | 1558547653
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Entity Type | Organization
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Legal Business Name | STORKS, P.S.
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Dates
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Enumeration Date | 01/18/2008
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Last Update Date | 01/18/2008
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Provider Practice Location Address
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Address Line | 2703 JAHN AVE NW SUITE C-5
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City | GIG HARBOR
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State | WA
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Zip | 98335-7977
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Country | US
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Telephone | 253-851-6992
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Fax | 253-858-3425
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Provider Business Mailing Address
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Address Line | 2703 JAHN AVE NW #C-5
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City | GIG HARBOR
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State | WA
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Zip | 98335-7977
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Country | US
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Telephone | 253-851-6992
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Fax | 253-858-3425
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Authorized Official
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Title or Position | PRESIDENT
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Name | PETER R. KESLING
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Credential | M.D.
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Telephone | 253-851-6992
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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 | MD00012846
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License Number State | WA
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