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General NPI Number Information
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NPI Number | 1578774501
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Entity Type | Organization
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Legal Business Name | ISSAQUAH MEDICAL GROUP PLLC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/26/2007
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Provider Practice Location Address
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Address Line | 450 NW GILMAN BLVD STE 201
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone | 425-391-0705
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Fax |
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Provider Business Mailing Address
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Address Line | 450 NW GILMAN BLVD STE 201
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City | ISSAQUAH
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State | WA
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Zip | 98027-2483
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CLINIC ADMINISTRATOR
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Name | MICHAEL P HOURIGAN
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Credential |
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Telephone | 425-391-0705
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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