Provider Demographics
NPI:1104595347
Name:LIVER INSTITUTE NORTHWEST PLLC
Entity type:Organization
Organization Name:LIVER INSTITUTE NORTHWEST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KRIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOWDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-536-3030
Mailing Address - Street 1:3216 NE 45TH PL STE 212
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4028
Mailing Address - Country:US
Mailing Address - Phone:206-536-3030
Mailing Address - Fax:206-524-0749
Practice Address - Street 1:3216 NE 45TH PL STE 212
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4028
Practice Address - Country:US
Practice Address - Phone:206-536-3030
Practice Address - Fax:206-524-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-10
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2154719Medicaid