Provider Demographics
NPI:1073886479
Name:ISSAQUAH FOOT & ANKLE SPECIALISTS, P.L.L.C.
Entity Type:Organization
Organization Name:ISSAQUAH FOOT & ANKLE SPECIALISTS, P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-391-8666
Mailing Address - Street 1:450 NW GILMAN BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-2483
Mailing Address - Country:US
Mailing Address - Phone:425-391-8666
Mailing Address - Fax:425-392-6433
Practice Address - Street 1:450 NW GILMAN BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2483
Practice Address - Country:US
Practice Address - Phone:425-391-8666
Practice Address - Fax:425-392-6433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-15
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601627348213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0508260001Medicare NSC