| Evergreenhealth Lakeshore Bothell | |
|
10131 Main St Bothell WA 98011-3425 | |
| (425) 485-3955 | |
| (425) 485-1476 |
| Full Name | Evergreenhealth Lakeshore Bothell |
|---|---|
| Speciality | Family Medicine |
| Location | 10131 Main St, Bothell, Washington |
| Authorized Official Name and Position | Robert Malte (CEO) |
| Authorized Official Contact | 4258992610 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreenhealth Lakeshore Bothell 10025 Ne 186th St Bothell WA 98011-3839 Ph: (425) 486-9131 | Evergreenhealth Lakeshore Bothell 10131 Main St Bothell WA 98011-3425 Ph: (425) 485-3955 |
| NPI Number | 1013450386 |
|---|---|
| Provider Enumeration Date | 11/18/2016 |
| Last Update Date | 11/18/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013450386 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
| 207R00000X | Internal Medicine | () | Secondary |
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