Provider Demographics
NPI:1275690463
Name:SANA ISA PRATT MD PLLC
Entity Type:Organization
Organization Name:SANA ISA PRATT MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SANA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISA-PRATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-803-0136
Mailing Address - Street 1:10413 NE 37TH CIR BLDG 3
Mailing Address - Street 2:SUITE B
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7924
Mailing Address - Country:US
Mailing Address - Phone:425-803-0136
Mailing Address - Fax:425-803-9864
Practice Address - Street 1:10413 NE 37TH CIR BLDG 3
Practice Address - Street 2:SUITE B
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-7924
Practice Address - Country:US
Practice Address - Phone:425-803-0136
Practice Address - Fax:425-803-9864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA=========OtherTAX ID #
WA=========OtherTAX ID #
WAH05519Medicare UPIN