Provider Demographics
NPI:1568720126
Name:WISE PATIENT INTERNAL MEDICINE
Entity Type:Organization
Organization Name:WISE PATIENT INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MSC
Authorized Official - Phone:206-466-5937
Mailing Address - Street 1:613 19TH AVE E
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4075
Mailing Address - Country:US
Mailing Address - Phone:206-466-5937
Mailing Address - Fax:206-535-8844
Practice Address - Street 1:613 19TH AVE E
Practice Address - Street 2:STE 201
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4075
Practice Address - Country:US
Practice Address - Phone:206-437-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA41388207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8892127Medicare PIN