Individual
IVAN MEDVEDEV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1959 NE PACIFIC ST, BOX 356422, SEATTLE, WA 98195-0001
(857) 919-6367
Mailing address
7001 SEAVIEW AVE NW STE 160-211, SEATTLE, WA 98117-6006
(857) 919-6367
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD60222650
WA
207RC0000X
Cardiovascular Disease Physician
Primary
MD60222650
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1629236187
—
WA
Enumeration date
05/30/2008
Last updated
06/17/2021
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