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General NPI Number Information
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NPI Number | 1619926870
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Entity Type | Organization
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Legal Business Name | GREENLAKE PLACE PC, INC.
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 6800 EAST GREENLAKE WAY N #200
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City | SEATTLE
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State | WA
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Zip | 98115
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Country | US
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Telephone | 206-524-5656
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Fax | 206-524-2841
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Provider Business Mailing Address
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Address Line | 6800 EAST GREENLAKE WAY N #200
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City | SEATTLE
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State | WA
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Zip | 98115
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Country | US
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Telephone | 206-524-5656
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Fax | 206-524-2841
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | JONATHAN I. GREENE
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Credential |
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Telephone | 206-528-2663
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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 |
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License Number State |
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