Provider Demographics
NPI:1427109271
Name:LAKE WASHINGTON PRIVATE MEDICINE INC
Entity type:Organization
Organization Name:LAKE WASHINGTON PRIVATE MEDICINE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:NAIBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-678-8534
Mailing Address - Street 1:13122 120TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-3014
Mailing Address - Country:US
Mailing Address - Phone:425-678-8534
Mailing Address - Fax:425-678-8564
Practice Address - Street 1:13122 120TH AVE NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3014
Practice Address - Country:US
Practice Address - Phone:425-678-8534
Practice Address - Fax:425-678-8564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602289671208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty