Provider Demographics
NPI:1740980630
Name:KLINIC MEDICAL PLLC
Entity type:Organization
Organization Name:KLINIC MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANEEL
Authorized Official - Middle Name:
Authorized Official - Last Name:URSANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-495-0724
Mailing Address - Street 1:1201 2ND AVE STE 900
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-3020
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1930 VILLAGE CENTER CIR # 3-6136
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-6299
Practice Address - Country:US
Practice Address - Phone:206-495-0724
Practice Address - Fax:877-823-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-08
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty