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Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Eastside ENT
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
12333 NE 130TH LN STE 440, KIRKLAND, WA 98034-7467
(425) 899-3838
(425) 671-0367
Mailing address
1800 116TH AVE NE STE 102, BELLEVUE, WA 98004-3043
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2001403
—
WA
01
—
222338
WA LABOR & INDUSTRIES
WA
Enumeration date
12/27/2012
Last updated
05/27/2021
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