Basic Information
| Provider Information | |||||||||
| NPI: | 1043468101 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | URITSKIY | ||||||||
| FirstName: | IGOR | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | MS 315010 | ||||||||
| Address2: | PO BOX 3947 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256885670 | ||||||||
| FaxNumber: | 4256356388 | ||||||||
| Practice Location | |||||||||
| Address1: | 1740 NW MAPLE ST | ||||||||
| Address2: | STE 111 | ||||||||
| City: | ISSAQUAH | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98027 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4253941200 | ||||||||
| FaxNumber: | 4253940100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/03/2008 | ||||||||
| LastUpdateDate: | 06/27/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 06/27/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | 81863 | IL | N | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | 235Z00000X | MD60153763 | WA | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 208100000X | MD60153763 | WA | Y | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 2075182 | 05 | WA | MEDICAID |