MEDICARE: DR. LEWIS RIELEY 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	390200000X	Student in an Organized Health Care Education/Training Program	240636	MA
2	390200000X	Student in an Organized Health Care Education/Training Program	ML 60161072	WA

General Provider Information

NPI Number	:	1548499825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEWIS RIELEY M.D.

Provider Business Mailing Address
First Line	:	BOX 356540
Second Line	:	1959 NE PACIFIC ST, BB-1469
City	:	SEATTLE
State	:	WA
Zip	:	98195-6540
Country	:	US
Telephone Number	:	206-543-2470
Fax Number	:	206-543-2958

Provider Business Practice Location Address
First Line	:	1959 NE PACIFIC ST, BB-1469
Second Line	:	BOX 356540
City	:	SEATTLE
State	:	WA
Zip	:	98195-6540
Country	:	US
Telephone Number	:	206-543-2470
Fax Number	:	206-543-2958

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

Provider Enumeration Date	:	07/08/2009
Last Update Date	:	10/15/2012

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