Provider Demographics
NPI:1124181102
Name:FOURNARAKIS, BILL M (MD)
Entity Type:Individual
Prefix:
First Name:BILL
Middle Name:M
Last Name:FOURNARAKIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14711 NE 29TH PL STE 255
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-8615
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2700 NORTHUP WAY
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1463
Practice Address - Country:US
Practice Address - Phone:425-827-4600
Practice Address - Fax:425-828-2256
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043070208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8409914Medicaid
WA8808275Medicare ID - Type Unspecified
WA8409914Medicaid