Provider Demographics
NPI:1609108042
Name:SEATTLE INTERNAL MEDICINE, PLLC
Entity Type:Organization
Organization Name:SEATTLE INTERNAL MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:STAMBOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-368-1311
Mailing Address - Street 1:1530 N 115TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8421
Mailing Address - Country:US
Mailing Address - Phone:206-368-1311
Mailing Address - Fax:206-366-0907
Practice Address - Street 1:1530 N 115TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8421
Practice Address - Country:US
Practice Address - Phone:206-368-1311
Practice Address - Fax:206-366-0907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037102207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB22495Medicare PIN
WA1093760316Medicare NSC
WAD50373Medicare UPIN