# MYLAUREL MEDICAL GROUP WA, PLLC

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

## Provider details

- **NPI number:** 1689557340
- **Authorized official:** BRANKO KOLVEK (COO)
- **Authorized official phone:** (347) 497-2452

## Contact information

- **Practice address:** 8756 GRAND AVE NE, BAINBRIDGE ISLAND, WA 98110-2905
- **Practice address phone:** (917) 613-9004
- **Mailing address:** 885 3RD AVE FL 29, NEW YORK, NY 10022-4834
- **Mailing address phone:** (917) 613-9004

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2025
- **Last updated:** 02/11/2026