Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Esravila Ariya Wibisono, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1972233708

Esravila Ariya Wibisono, MD is an Internal Medicine in Bonney Lake, Washington. Qualified in 2018, 8 years ago. Practices with Multicare Health System, a 2,302-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Connecticut and Washington.

Years since qualifying
8
Licensed in
CT, WA
In the registry since
2022
Specialties on file
2
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

10004 204th Ave E Ste 2200
Bonney Lake, WA 98391-6537
Phone: (253) 447-3300
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 56 Franklin St Ste 1, Waterbury, CT 06706-1281 — (203) 709-8685

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence MD61603415 (WA)
Student in an Organized Health Care Education/Training Program Taxonomy 390200000X · Licence 06-0646844 (CT)

Record details

NPI number1972233708
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedJune 14, 2022
Last updated in NPPESJuly 31, 2025
Certification dateJuly 31, 2025
Mailing address10004 204th Ave E Ste 2200, Bonney Lake, WA 98391-6537

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyINTERNAL MEDICINE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Multicare Health System — 2302 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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