Maksportsmd
Family Medicine, Sports Medicine in Bothell, WA. Organization (NPI-2).
NPI number1417469404
StatusActive
Last updated in NPPESOct 30, 2017
Details
- NPI
- 1417469404
- Entity type
- Organization (NPI-2)
- Legal business name
- Maksportsmd
- Organization subpart
- No
- Enumeration date
- Oct 30, 2017
- Last updated
- Oct 30, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207QS0010X | Family Medicine, Sports Medicine | 60465979 | WA | Yes |
Practice location
19110 Bothell Way Ne Ste 102Bothell, WA 98011-2970
Phone 425-286-8271 · Fax 425-491-7271
Mailing address
19110 Bothell Way Ne Ste 102Bothell, WA 98011-2970
Authorized official
Abimbolu Makinde
Owner
4252868271
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