MEDICARE: LAKE WASHINGTON VASCULAR 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	2086S0129X	Vascular Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH9340	OTHER	WA	RR MEDICARE

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

General Provider Information

NPI Number	:	1942292875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKE WASHINGTON VASCULAR PLLC

Provider Business Mailing Address
First Line	:	PO BOX 94732
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98124-7032
Country	:	US
Telephone Number	:	425-453-1772
Fax Number	:	425-453-0603

Provider Business Practice Location Address
First Line	:	1135 116TH AVE NE STE 305
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	425-453-1772
Fax Number	:	425-453-0603

Authorized Official
Title or Position	:	MANAGING PARTNER, PLLC
Name	:	DANIEL PEPPER
Credential	:	MD
Telephone Number	:	425-453-1772

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	02/25/2015

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Directions to “LAKE WASHINGTON VASCULAR PLLC ” Practice Location

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