Provider Demographics
NPI:1134667306
Name:AKR MEDICAL PLLC
Entity Type:Organization
Organization Name:AKR MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KRISTINE
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-658-0658
Mailing Address - Street 1:16701 CLEVELAND ST STE C
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-0901
Mailing Address - Country:US
Mailing Address - Phone:425-658-0658
Mailing Address - Fax:425-658-5303
Practice Address - Street 1:16701 CLEVELAND ST STE C
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-0901
Practice Address - Country:US
Practice Address - Phone:425-658-0658
Practice Address - Fax:425-658-5303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA604061445261QP1100X
WA604-061-445332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2078791Medicaid