| Dr Jake Bergstrom, MD | |
|
17500 Se 392nd St, Auburn, WA 98092-9705 | |
| (253) 939-6648 | |
| Not Available |
| Full Name | Dr Jake Bergstrom |
|---|---|
| Gender | Male |
| Speciality | Internal Medicine |
| Location | 17500 Se 392nd St, Auburn, Washington |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134289051 | NPI | - | NPPES |
| 9109BE | Other | WA | REGENCE BLUE SHIELD |
| 1043009 | Medicaid | WA | |
| 1107507 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD00020595 (Washington) | Primary |
| Entity Name | Muckleshoot Indian Tribe |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1558448175 PECOS PAC ID: 5092724286 Enrollment ID: O20060417000580 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Jake Bergstrom, MD Po Box 570, Oakville, WA 98568 Ph: (360) 273-5504 | Dr Jake Bergstrom, MD 17500 Se 392nd St, Auburn, WA 98092-9705 Ph: (253) 939-6648 |
Eduardo Gil De Rubio, MD Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 202 N Division St, Auburn, WA 98001 Phone: 253-833-7711 | |
Dr. Robert Todd Middleton, M.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 202 N Division St, Ste 201, Auburn, WA 98001 Phone: 253-939-1230 Fax: 253-735-1211 | |
Abdul R Siddiqui, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 202 N Division St Ste 301, Auburn, WA 98001 Phone: 253-288-3040 | |
Dr. Krystoff J. Godlewski, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 202 N Division St, Plaza 2 Suite 201, Auburn, WA 98001 Phone: 253-939-1230 Fax: 253-735-6479 | |
Dr. James Martin Wagner, M.D. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 202 N Division St, Plaza 2 Suite 201, Auburn, WA 98001 Phone: 253-939-1230 | |
Madhavi Reddy Mandala, MD Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 202 N Division St Ste 301, Auburn, WA 98001 Phone: 253-833-7256 |