Provider Demographics
NPI:1275166282
Name:LAKE WASHINGTON INTERNAL MEDICINE PLLC
Entity type:Organization
Organization Name:LAKE WASHINGTON INTERNAL MEDICINE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAWKY
Authorized Official - Suffix:
Authorized Official - Credentials:MDPHD
Authorized Official - Phone:206-898-2416
Mailing Address - Street 1:14410 NE BEL RED RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3953
Mailing Address - Country:US
Mailing Address - Phone:206-898-2416
Mailing Address - Fax:206-466-6278
Practice Address - Street 1:14410 NE BEL RED RD STE 100
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3953
Practice Address - Country:US
Practice Address - Phone:206-898-2416
Practice Address - Fax:206-466-6278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-18
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1275166282OtherGROUP NPI