# MERCER ISLAND FAMILY MEDICINE, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1194928697
- **Authorized official:** DR. SCOTT EDWARD FANNIN D.O. (PRESIDENT)
- **Authorized official phone:** (586) 850-4645

## Contact information

- **Practice address:** 3003 ISLAND CREST WAY, MERCER ISLAND, WA 98040-2998
- **Practice address phone:** (586) 850-4645
- **Mailing address:** 54196 KATHERINE WOOD DR, MACOMB, MI 48042-2315
- **Mailing address phone:** (586) 850-4645

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | OP00002196 | WA | Yes |

## Other

- **Enumeration date:** 06/11/2007
- **Last updated:** 08/22/2020