Provider Demographics
NPI:1578659678
Name:LAVINDER, IMKA (DO)
Entity Type:Individual
Prefix:
First Name:IMKA
Middle Name:
Last Name:LAVINDER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:316 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:#212
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-383-5777
Mailing Address - Fax:253-627-0855
Practice Address - Street 1:4700 PT FOSDICK DR NW
Practice Address - Street 2:#211
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-851-5665
Practice Address - Fax:253-627-0855
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAOP00001745208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8283335Medicaid
AB24069Medicare ID - Type Unspecified
WA8283335Medicaid