Provider Demographics
NPI:1962628198
Name:KANSAKAR, ERINA (MD)
Entity type:Individual
Prefix:
First Name:ERINA
Middle Name:
Last Name:KANSAKAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERINA
Other - Middle Name:
Other - Last Name:KANSAKAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 110
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-901-8980
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:16233 SYLVESTER RD SW STE 110
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-901-8980
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301088810208600000X
WAMD60841489208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2106418Medicaid