Provider Demographics
NPI:1942242342
Name:SHORELINE FAMILY PRACTICE LLP
Entity Type:Organization
Organization Name:SHORELINE FAMILY PRACTICE LLP
Other - Org Name:FAMILY MEDICINE AT CARKEEK PARK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CREELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-870-2367
Mailing Address - Street 1:PO BOX 77070
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-0070
Mailing Address - Country:US
Mailing Address - Phone:425-870-2367
Mailing Address - Fax:360-403-3392
Practice Address - Street 1:9776 HOLMAN RD NW
Practice Address - Street 2:SUITE 102
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98117-2000
Practice Address - Country:US
Practice Address - Phone:425-870-2367
Practice Address - Fax:360-403-3392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096985Medicaid
WA7096985Medicaid