OrganizationActive
Creekside Medical LLC
NPI 1487167052 · Electrodiagnostic Medicine Physician · Cheyenne, WY
Provider details
- NPI number
- 1487167052
- Entity type
- Organization
- Primary specialty
- Electrodiagnostic Medicine PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Matthew Wavra, Managing Member(425) 890-6239
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1910 Thomes Ave
Cheyenne, WY 82001-3527
Phone: (425) 890-6239
Approximate (ZIP-level) locationGet directions
Mailing address
4580 Klahanie Dr Se # 252
Issaquah, WA 98029-5812
Registry dates
- Enumerated
- 2017-11-06
- Last updated
- 2018-09-20
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.