| Interlake Medical Center, Pllc | |
|
2103 152nd Ave Ne Redmond WA 98052-5520 | |
| (425) 746-2400 | |
| (425) 746-2659 |
| Full Name | Interlake Medical Center, Pllc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2103 152nd Ave Ne, Redmond, Washington |
| Authorized Official Name and Position | Norman H. Leou (MANAGING DIRECTOR) |
| Authorized Official Contact | 4257462400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Interlake Medical Center, Pllc 2103 152nd Ave Ne Redmond WA 98052-5520 Ph: (425) 746-2400 | Interlake Medical Center, Pllc 2103 152nd Ave Ne Redmond WA 98052-5520 Ph: (425) 746-2400 |
| NPI Number | 1619998978 |
|---|---|
| Provider Enumeration Date | 07/22/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0446242242 |
|---|---|
| Medicare Enrollment ID | O20040401000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619998978 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Srobona Mitra |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1770601353 PECOS PAC ID: 1052461902 Enrollment ID: I20090615000509 |
| Provider Name | Jackline S Joseph |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1407889173 PECOS PAC ID: 6507858305 Enrollment ID: I20101117000052 |
| Provider Name | John I Yam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699782367 PECOS PAC ID: 9739377110 Enrollment ID: I20101229000739 |
| Provider Name | Horng Min H Leou |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427083419 PECOS PAC ID: 9133308133 Enrollment ID: I20110124000340 |
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