Organization
OVERLAKE MEDICAL CLINICS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID SCHULTZ (COO)
(425) 688-5470
Entity
Organization
Contact information
Practice address
1135 116TH AVE NE, SUITE 110, BELLEVUE, WA 98004
(425) 688-5670
(425) 688-5124
Mailing address
PO BOX 3947, MS 315010, SEATTLE, WA 98124-3947
(425) 688-5670
(425) 688-5139
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7102015
—
WA
Enumeration date
07/06/2006
Last updated
10/16/2013
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