Organization
EASTSIDE INTERNAL MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DOUGLAS A PORTELANCE (MD PRESIDENT)
(425) 899-6700
Entity
Organization
Contact information
Practice address
12333 NE 120TH LN. STE 310, KIRKLAND, WA 98034
(425) 899-6700
(425) 899-6701
Mailing address
12333 NE 120TH LN. STE 310, KIRKLAND, WA 98034
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145684
LABOR & INDUSTRIES
WA
Enumeration date
01/05/2007
Last updated
12/18/2007
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