Provider Demographics
NPI:1144362005
Name:GREENLAKE PLASTIC SURGERY, PLLC
Entity type:Organization
Organization Name:GREENLAKE PLASTIC SURGERY, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CHATAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-292-6226
Mailing Address - Street 1:1037 NE 65TH ST # 336
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-6655
Mailing Address - Country:US
Mailing Address - Phone:206-292-6226
Mailing Address - Fax:
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:SUITE #1520
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3588
Practice Address - Country:US
Practice Address - Phone:206-292-6226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037134174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1119726Medicaid
WA1386720878OtherNPI PROVIEDER
WAG8803653Medicare PIN
H02661Medicare UPIN