MEDICARE: DR. EDANILI SAGUN LACAR M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	K1518	TX
2	208000000X	Pediatrics Physician	K1518	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	K0099021	OTHER	TX	DPS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	K1518	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1003813122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDANILI SAGUN LACAR M.D.

Provider Business Mailing Address
First Line	:	2153 E BEAVER LAKE DR SE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-7921
Country	:	US
Telephone Number	:	956-793-7888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2153 E BEAVER LAKE DR SE
Second Line	:
City	:	SAMMAMISH
State	:	WA
Zip	:	98075-7921
Country	:	US
Telephone Number	:	956-793-7888
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	03/07/2023

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Directions to “ DR. EDANILI SAGUN LACAR M.D.” Practice Location

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