Provider Demographics
NPI:1760987853
Name:BILAN, MAKSYM
Entity Type:Individual
Prefix:
First Name:MAKSYM
Middle Name:
Last Name:BILAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19586 10TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7332
Mailing Address - Country:US
Mailing Address - Phone:360-697-2122
Mailing Address - Fax:360-697-4617
Practice Address - Street 1:19586 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7332
Practice Address - Country:US
Practice Address - Phone:360-697-2122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60780327225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WABILANM234R4OtherSTATE ISSUED DRIVER'S LICENSE