=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578623088
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAHER M. ANOUS M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10117 NE 58TH ST
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-576-8120
-----------------------------------------------------
Fax | 425-576-8126
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5726 LAKE WASHINGTON BLVD NE S-1
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98033-7425
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-576-8120
-----------------------------------------------------
Fax | 425-576-8126
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | MD00021511
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------