Provider Demographics
NPI:1346435765
Name:ISB.INC
Entity Type:Organization
Organization Name:ISB.INC
Other - Org Name:ADVANCED FOOT & ANKLE CLINIC OF BELLEVUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:425-643-8901
Mailing Address - Street 1:2001 152ND AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5521
Mailing Address - Country:US
Mailing Address - Phone:425-643-8901
Mailing Address - Fax:425-643-8902
Practice Address - Street 1:2001 152ND AVE NE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-5521
Practice Address - Country:US
Practice Address - Phone:425-643-8901
Practice Address - Fax:425-643-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000799213E00000X, 213ES0131X
WAPO00000798213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0211559OtherL&I
WA7133754Medicaid
WA8458416Medicaid
WA8458432Medicaid
WA0211560OtherL&I
WA0211557OtherL&I
WA8859781Medicare PIN
WAV09080Medicare UPIN
WAV09079Medicare UPIN
WA8859783Medicare PIN
WA8859782Medicare PIN
WA0211557OtherL&I
WA0211559OtherL&I