Provider Demographics
NPI:1710027818
Name:ARBOR HEIGHTS CLINIC, P S
Entity Type:Organization
Organization Name:ARBOR HEIGHTS CLINIC, P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MEDECK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:206-932-2600
Mailing Address - Street 1:4005 SW 100TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-3638
Mailing Address - Country:US
Mailing Address - Phone:206-932-2600
Mailing Address - Fax:
Practice Address - Street 1:4005 SW 100TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98146-3638
Practice Address - Country:US
Practice Address - Phone:206-932-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000772207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE20231Medicare UPIN