MEDICARE: CENTER FOR WEIGHT LOSS SURGERY PLLC

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	208600000X	Surgery Physician	MD00033726	WA

General Provider Information

NPI Number	:	1245267327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR WEIGHT LOSS SURGERY PLLC

Provider Business Mailing Address
First Line	:	34509 9TH AVE. SOUTH
Second Line	:	SUITE 103
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-8707
Country	:	US
Telephone Number	:	253-815-7774
Fax Number	:	253-815-7708

Provider Business Practice Location Address
First Line	:	34509 9TH AVE. SOUTH
Second Line	:	SUITE 103
City	:	FEDERAL WAY
State	:	WA
Zip	:	98003-8707
Country	:	US
Telephone Number	:	253-815-7774
Fax Number	:	253-815-7708

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MYUR S SRIKANTH
Credential	:	M. D.
Telephone Number	:	253-815-7774

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	08/22/2020

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