Esravila Ariya Wibisono, MD

NPI #1972233708 in Bonney Lake, Washington

Provider Information

NPI Number: 1972233708
Entity Type: Individual
Name: Esravila Ariya Wibisono, MD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Internal Medicine
Credential: MD
Enumeration Date: Jun 14, 2022
Last Updated: Jul 31, 2025

Practice Location

Address: 10004 204TH AVE E STE 2200
City: Bonney Lake
State: Washington
ZIP Code: 98391-6537
Phone: (253) 447-3300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Student in an Organized Health Care Education/Training Program	390200000X
Internal Medicine	207R00000X	Primary

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