MEDICARE: STEPHANI J. AMSTADTER 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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	241321-1	NY
2	207Q00000X	Family Medicine Physician	MD60031114	WA

General Provider Information

NPI Number	:	1750329777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANI J. AMSTADTER M.D.

Provider Business Mailing Address
First Line	:	1600 116TH AVE NE
Second Line	:	STE 102
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3055
Country	:	US
Telephone Number	:	253-584-3023
Fax Number	:	253-582-1222

Provider Business Practice Location Address
First Line	:	5920 - 100TH ST. SW #31
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98499-2751
Country	:	US
Telephone Number	:	253-584-3023
Fax Number	:	253-582-1222

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	08/10/2016

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