NPI 1487167052

Creekside Medical LLC

Organisation Electrodiagnostic Medicine Physician Cheyenne, WY

Practice location

Address: 1910 Thomes Ave, Cheyenne, WY 82001-3527
Phone: (425) 890-6239
Mailing address: 4580 Klahanie Dr SE # 252, Issaquah, WA 98029-5812

Authorised official

Name: Matthew Wavra
Title: Managing Member
Phone: (425) 890-6239

Registered specialties

Electrodiagnostic Medicine Physician Primary

Allopathic & Osteopathic Physicians Taxonomy 204R00000X

Other Electrodiagnostic Medicine providers in Wyoming →

Registry record

NPI: 1487167052
Entity type: Organization
NPI issued: 6 Nov 2017
Record last updated: 20 Sep 2018

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.