Provider Demographics
NPI:1790007144
Name:IM&G PLLC
Entity Type:Organization
Organization Name:IM&G PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:V
Authorized Official - Last Name:PITTIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-870-4470
Mailing Address - Street 1:PO BOX 84511
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5811
Mailing Address - Country:US
Mailing Address - Phone:206-439-2988
Mailing Address - Fax:206-242-7247
Practice Address - Street 1:22000 MARINE VIEW DR S
Practice Address - Street 2:SUITE 100
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6233
Practice Address - Country:US
Practice Address - Phone:206-870-4460
Practice Address - Fax:206-870-4770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00013480207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty