Provider Demographics
NPI:1780633750
Name:S IYABO TINUBU KARCH MD PLLC
Entity Type:Organization
Organization Name:S IYABO TINUBU KARCH MD PLLC
Other - Org Name:IYABO WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SIKIRAT
Authorized Official - Middle Name:IYABO
Authorized Official - Last Name:TINUBU KARCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-357-3636
Mailing Address - Street 1:PO BOX 13684
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98198
Mailing Address - Country:US
Mailing Address - Phone:206-357-3636
Mailing Address - Fax:206-357-3655
Practice Address - Street 1:1101 MADISON STREET
Practice Address - Street 2:STE 1250
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1306
Practice Address - Country:US
Practice Address - Phone:206-357-3636
Practice Address - Fax:206-357-3655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G93949Medicare UPIN
WA8858342Medicare ID - Type Unspecified