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
8301 161ST AVE NE STE 200, REDMOND, WA 98052-3858
(425) 869-4855
(425) 869-4858
Mailing address
1810 116TH AVE NE STE 102, BELLEVUE, WA 98004-3058
(425) 451-3710
(425) 451-2636
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
601484763
WA
207Y00000X
Otolaryngology Physician
Primary
—
—
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
08/21/2007
Last updated
05/28/2021
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