Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A122484 | CA |
Y | 2080P0216X | Pediatric Rheumatologist | 60457123 | WA |
NPI | 1104111939 |
---|---|
Provider Name | Dr. Sriharsha Cherukumilli Grevich |
First Address | Seattle, WA 98105-3901 |
Second Address | Seattle, WA 98105-3901 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2011 |
Last Update Date | 14/09/2018 |