Provider Demographics
NPI:1275748691
Name:ILES-SHIH, LULU (MD)
Entity Type:Individual
Prefix:DR
First Name:LULU
Middle Name:
Last Name:ILES-SHIH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 MADISON STREET
Mailing Address - Street 2:SUITE #1220
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:STE. 1220
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3588
Practice Address - Country:US
Practice Address - Phone:206-215-4250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD29111207R00000X
WAMD60316515207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1275748691Medicaid