Provider Demographics
NPI:1356524060
Name:ABULHOSN, MAK SAMI (DPM)
Entity type:Individual
Prefix:DR
First Name:MAK
Middle Name:SAMI
Last Name:ABULHOSN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3236 78TH AVE SE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3500
Mailing Address - Country:US
Mailing Address - Phone:206-275-9117
Mailing Address - Fax:206-275-3693
Practice Address - Street 1:3236 78TH AVE SE
Practice Address - Street 2:SUITE 201
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-3500
Practice Address - Country:US
Practice Address - Phone:206-275-9117
Practice Address - Fax:206-275-3693
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAPO730213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00436323OtherRAILROAD MEDICARE
WA8314536Medicaid
WAG8857731Medicare PIN
WAU90809Medicare UPIN