Provider Demographics
NPI:1295831659
Name:MEDANI, IGNATIUS C (MD)
Entity Type:Individual
Prefix:MR
First Name:IGNATIUS
Middle Name:C
Last Name:MEDANI
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 1:34716 1ST AVE S
Mailing Address - Street 2:#A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-517-7058
Mailing Address - Fax:253-517-7139
Practice Address - Street 1:34716 1ST AVE S
Practice Address - Street 2:#A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003
Practice Address - Country:US
Practice Address - Phone:253-517-7058
Practice Address - Fax:253-517-7058
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2013-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00028366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F26964Medicare UPIN
WAAB2641ZMedicare ID - Type Unspecified