Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RX0202X | Medical Oncology | MD00038783 | WA |
NPI | 1154401123 |
---|---|
Provider Name | Marco Bernd Mielcarek |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98109 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 06/09/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0231623 | L&I (01) | WA |
1154401123 | (05) | WA |
233700 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
H94919 | (02) |