# RENOVO MEDICAL GROUP

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

## Provider details

- **NPI number:** 1275931982
- **Authorized official:** CHERYL HAMILL (OPERATIONS MANAGER)
- **Authorized official phone:** (425) 778-2220

## Contact information

- **Practice address:** 19930 BALLINGER WAY NE, SHORELINE, WA 98155-1223
- **Practice address phone:** (425) 778-2220
- **Mailing address:** 19930 BALLINGER WAY NE, SHORELINE, WA 98155-1223
- **Mailing address phone:** (425) 778-2220

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QA0505X | Adult Medicine Physician | — | NULL | Yes |
| 207QA0505X | Adult Medicine Physician | — | — | Yes |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | — |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | NULL | — |
| 207QS1201X | Sleep Medicine (Family Medicine) Physician | — | — | — |
| 208600000X | Surgery Physician | — | NULL | — |
| 208600000X | Surgery Physician | — | — | — |

## Other

- **Enumeration date:** 12/11/2014
- **Last updated:** 06/20/2018