Provider Demographics
NPI:1801097563
Name:TACOMA MEDICAL ASSOCIATES PS
Entity type:Organization
Organization Name:TACOMA MEDICAL ASSOCIATES PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHMET
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-588-5522
Mailing Address - Street 1:5920 100TH ST SW
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-2751
Mailing Address - Country:US
Mailing Address - Phone:253-588-5522
Mailing Address - Fax:253-588-7711
Practice Address - Street 1:5920 100TH ST SW
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2751
Practice Address - Country:US
Practice Address - Phone:253-588-5522
Practice Address - Fax:253-588-7711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00041606174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8325870Medicaid
WA1629102769OtherNPI
WA=========OtherTIN
WAMD00041606Medicare ID - Type Unspecified
WA8325870Medicaid