| Maksportsmd | |
|
19110 Bothell Way Ne Ste 102 Bothell WA 98011-2970 | |
| (425) 286-8271 | |
| (425) 491-7271 |
| Full Name | Maksportsmd |
|---|---|
| Speciality | Family Medicine |
| Location | 19110 Bothell Way Ne Ste 102, Bothell, Washington |
| Authorized Official Name and Position | Abimbolu Makinde (OWNER) |
| Authorized Official Contact | 4252868271 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Maksportsmd 19110 Bothell Way Ne Ste 102 Bothell WA 98011-2970 Ph: () - | Maksportsmd 19110 Bothell Way Ne Ste 102 Bothell WA 98011-2970 Ph: (425) 286-8271 |
| NPI Number | 1417469404 |
|---|---|
| Provider Enumeration Date | 10/30/2017 |
| Last Update Date | 10/30/2017 |
| Medicare PECOS PAC ID | 9739448234 |
|---|---|
| Medicare Enrollment ID | O20180108002433 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417469404 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | 60465979 (Washington) | Primary |
| Provider Name | Quynh-anh T Phan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255791414 PECOS PAC ID: 7012214190 Enrollment ID: I20160405001455 |
| Provider Name | Abimbolu S. Makinde |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1669769337 PECOS PAC ID: 7618285982 Enrollment ID: I20180108002696 |
| Provider Name | Yanqun Bu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457697526 PECOS PAC ID: 0840545141 Enrollment ID: I20180608001137 |
| Provider Name | Amanda S Macklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1740707967 PECOS PAC ID: 2567737182 Enrollment ID: I20200529000614 |
| Provider Name | Adam Pourcho |
|---|---|
| Provider Type | Practitioner - Osteopathic Manipulative Medicine |
| Provider Identifiers | NPI Number: 1851603161 PECOS PAC ID: 1658533625 Enrollment ID: I20210914000011 |
| Provider Name | Jessica Taylor |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1851069538 PECOS PAC ID: 1355730607 Enrollment ID: I20211108002898 |
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