1841779485 NPI number — DR. FUNKE ADEFOPE WISHKO MD

Table of content: DR. FUNKE ADEFOPE WISHKO MD (NPI 1841779485)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841779485 NPI number — DR. FUNKE ADEFOPE WISHKO MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WISHKO
Provider First Name:
FUNKE
Provider Middle Name:
ADEFOPE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADEFOPE
Provider Other First Name:
FUNKE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841779485
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3612 216TH DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98036-8096
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
470-214-3374
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12303 NE 130TH LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIRKLAND
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98034-3099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-544-1000
Provider Business Practice Location Address Fax Number:
425-544-1001
Provider Enumeration Date:
08/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  MD61283257 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LL3299 . This is a "NEVADA STATE BOARD OF MEDICAL EXAMINERS" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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