Provider Demographics
NPI:1902013428
Name:ISB, INC
Entity Type:Organization
Organization Name:ISB, INC
Other - Org Name:ADVANCED FOOT & ANKLE CLINIC OF KENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ILONA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARLAM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:206-992-9914
Mailing Address - Street 1:4306 156TH AVE NE
Mailing Address - Street 2:TT-261
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-5304
Mailing Address - Country:US
Mailing Address - Phone:206-992-9914
Mailing Address - Fax:206-501-2102
Practice Address - Street 1:10056 SE 240TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5126
Practice Address - Country:US
Practice Address - Phone:206-992-9914
Practice Address - Fax:206-501-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0211560OtherL&I
WA5981360001OtherDMEPOS
WA0211559OtherL&I
WA0211557OtherL&I
WA7133754Medicaid
WA8458416Medicaid
WA8458432Medicaid
WA8859782Medicare PIN
WAV09079Medicare UPIN
WAG8859781Medicare ID - Type Unspecified
WA8859783Medicare PIN
WA0211559OtherL&I
WA0211560OtherL&I