Lakeshore Clinic Pllc | |
10131 Main St Bothell WA 98011-3425 | |
(425) 485-3955 | |
(425) 485-1476 |
Full Name | Lakeshore Clinic Pllc |
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Speciality | Family Medicine |
Location | 10131 Main St, Bothell, Washington |
Authorized Official Name and Position | Linda R Jeppesen (CEO) |
Authorized Official Contact | 4254853955 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Lakeshore Clinic Pllc Po Box 646 Bothell WA 98041-0646 Ph: (425) 485-3955 | Lakeshore Clinic Pllc 10131 Main St Bothell WA 98011-3425 Ph: (425) 485-3955 |
NPI Number | 1922052422 |
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Provider Enumeration Date | 05/19/2006 |
Last Update Date | 02/18/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1922052422 | NPI | - | NPPES |
G217116700 | Other | WA | PTAN |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
213E00000X | Podiatrist | (* (Not Available)) | Secondary |
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