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Medical Specialty
Professional ID
- NPI: 1154578789
- PECOS ID: 0244458560
- Enrollment ID: I20140828001710
- Credential(MD, DO, DPM):
- Medical School: Medical College Of Wisconsin
- Medical School Graduation Year: 2008
Hospital Service
- Hospital CCN1: 503300
- Business Name (LBN)1: Seattle Childrens Hospital
Medical Practices
- Organization Name: Association Of Chmc And University Physicians
- Group Practice ID assigned by PECOS: 9133032964
- Number of Group Practice member: 235
Location
- Address1: 4800 Sand Point Way Ne
- Address2:
- City: Seattle
- State: Washington
- Zip Code: 98105
- Phone Number: (206)526-2000
Medicare
- Medicare Assignment: Yes
- Report Quality of Care to Physician Quality Reporting System (PQRS):
- Used Electronic health record (EHR):