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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