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General NPI Number Information
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NPI Number | 1568720126
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Entity Type | Organization
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Legal Business Name | WISE PATIENT INTERNAL MEDICINE
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 06/29/2023
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Provider Practice Location Address
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Address Line | 613 19TH AVE E STE 201
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City | SEATTLE
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State | WA
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Zip | 98112-4075
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Country | US
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Telephone | 206-437-2884
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Fax |
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Provider Business Mailing Address
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Address Line | 613 19TH AVE E SUITE 201
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City | SEATTLE
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State | WA
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Zip | 98112-4075
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Country | US
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Telephone | 206-466-5937
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Fax | 206-535-8844
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Authorized Official
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Title or Position | CEO, FOUNDER
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Name | DR. SAM WARREN
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Credential | M.D., M.SC.
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Telephone | 206-466-5937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 41388
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License Number State | WA
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