Provider Demographics
NPI:1366416455
Name:KODE, SHAILA B (MD)
Entity type:Individual
Prefix:MS
First Name:SHAILA
Middle Name:B
Last Name:KODE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:9040 REID ST
Mailing Address - Street 2:ATTN MCHJ-QCR
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-1100
Mailing Address - Country:US
Mailing Address - Phone:253-968-2252
Mailing Address - Fax:253-968-3278
Practice Address - Street 1:9040 REID ST
Practice Address - Street 2:ATTN MCHJ-QCR
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-1100
Practice Address - Country:US
Practice Address - Phone:253-968-2252
Practice Address - Fax:253-968-3278
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WA16585207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN