Provider Demographics
NPI:1427575000
Name:INTEGRATIVE HEALTH INSTITUTE
Entity Type:Organization
Organization Name:INTEGRATIVE HEALTH INSTITUTE
Other - Org Name:SOPHIA HEALTH INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DIETRICH
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-402-4401
Mailing Address - Street 1:18106 140TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4312
Mailing Address - Country:US
Mailing Address - Phone:425-402-4401
Mailing Address - Fax:425-402-4389
Practice Address - Street 1:18106 140TH AVE NE
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4312
Practice Address - Country:US
Practice Address - Phone:425-402-4401
Practice Address - Fax:425-402-4389
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00022065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD00022065OtherMEDICAL LICENSE