Provider Demographics
NPI:1275612483
Name:MERCER ISLAND FOOT AND ANKLE CLINIC PLLC
Entity Type:Organization
Organization Name:MERCER ISLAND FOOT AND ANKLE CLINIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MAK
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABULHOSN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-275-9117
Mailing Address - Street 1:3236 78TH AVENUE SE
Mailing Address - Street 2:#201
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040
Mailing Address - Country:US
Mailing Address - Phone:206-275-9117
Mailing Address - Fax:206-275-3693
Practice Address - Street 1:3236 78TH AVENUE SE
Practice Address - Street 2:#201
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040
Practice Address - Country:US
Practice Address - Phone:206-275-9117
Practice Address - Fax:206-275-3693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO730213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADG4542OtherRAILROAD MEDICARE
WA7130693Medicaid
WA3488ABOtherREGENCE BCBS
U90809Medicare UPIN
WA3488ABOtherREGENCE BCBS