Individual
KENNETH Y IGBALODE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4011 TALBOT RD S STE 500, RENTON, WA 98055-5782
(425) 690-3482
(425) 690-9082
Mailing address
3600 LIND AVE SW, SUITE 100 ATTN CREDENTIALING, RENTON, WA 98057-4970
(425) 690-2715
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
L-255187
MA
207RC0000X
Cardiovascular Disease Physician
Primary
MD61041046
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2160257
—
WA
Enumeration date
06/05/2013
Last updated
08/04/2020
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