Organization
CREEKSIDE MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW WAVRA (MANAGING MEMBER)
(425) 890-6239
Entity
Organization
Contact information
Practice address
1910 THOMES AVE, CHEYENNE, WY 82001-3527
(425) 890-6239
Mailing address
4580 KLAHANIE DR SE # 252, ISSAQUAH, WA 98029-5812
(833) 613-9084
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
Primary
—
—
Other
Enumeration date
11/06/2017
Last updated
09/20/2018
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