Provider Demographics
NPI:1437223765
Name:MICHAEL TEPPER MD PS
Entity Type:Organization
Organization Name:MICHAEL TEPPER MD PS
Other - Org Name:ADVANCED HEALTHCARE NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TEPPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-802-0803
Mailing Address - Street 1:PO BOX 3509
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-0016
Mailing Address - Country:US
Mailing Address - Phone:360-802-0803
Mailing Address - Fax:360-802-0806
Practice Address - Street 1:1427 JEFFERSON AVE
Practice Address - Street 2:SUITE102
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-3649
Practice Address - Country:US
Practice Address - Phone:360-802-0803
Practice Address - Fax:360-802-0806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602-353-095261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care