MEDICARE: NORTHWEST PROFESSIONAL MEDICINE

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	174400000X	Specialist	MD00044383	WA

General Provider Information

NPI Number	:	1225303423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST PROFESSIONAL MEDICINE

Provider Business Mailing Address
First Line	:	93 S JACKSON ST
Second Line	:	21499
City	:	SEATTLE
State	:	WA
Zip	:	98104-2818
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	93 S JACKSON ST
Second Line	:	21499
City	:	SEATTLE
State	:	WA
Zip	:	98104-2818
Country	:	US
Telephone Number	:	206-257-2237
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELDI HAN
Credential	:	M.D.
Telephone Number	:	206-257-2237

Provider Enumeration Date	:	03/20/2012
Last Update Date	:	03/20/2012

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