Provider Demographics
NPI:1417794827
Name:KASOLU, ERICK M
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:M
Last Name:KASOLU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11821 82ND PL S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98178-5180
Mailing Address - Country:US
Mailing Address - Phone:832-605-6908
Mailing Address - Fax:
Practice Address - Street 1:11821 82ND PL S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98178-5180
Practice Address - Country:US
Practice Address - Phone:832-605-6908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)