Provider Demographics
NPI:1558547653
Name:STORKS, P.S.
Entity Type:Organization
Organization Name:STORKS, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:R
Authorized Official - Last Name:KESLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-851-6992
Mailing Address - Street 1:2703 JAHN AVE NW
Mailing Address - Street 2:#C-5
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7977
Mailing Address - Country:US
Mailing Address - Phone:253-851-6992
Mailing Address - Fax:253-858-3425
Practice Address - Street 1:2703 JAHN AVE NW
Practice Address - Street 2:SUITE C-5
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7977
Practice Address - Country:US
Practice Address - Phone:253-851-6992
Practice Address - Fax:253-858-3425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00012846174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB37947Medicare PIN