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General NPI Number Information
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NPI Number | 1952480899
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Entity Type | Organization
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Legal Business Name | PODIATRIC PHYSICIANS AND SURGEONS P.S.
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 11711 NE 12TH ST SUITE 1B
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City | BELLEVUE
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State | WA
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Zip | 98005
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Country | US
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Telephone | 425-453-1598
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Fax | 425-450-0029
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Provider Business Mailing Address
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Address Line | 11711 NE 12TH ST SUITE 1B
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City | BELLEVUE
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State | WA
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Zip | 98005-2461
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Country | US
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Telephone | 425-453-1498
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Fax | 425-450-0029
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Authorized Official
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Title or Position | DOCTOR OF PODIATRIC MEDICINE
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Name | DR. RONALD S KRIVOSHA
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Credential | DPM
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Telephone | 425-453-1598
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | P0OOO177
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License Number State | WA
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