Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 00024979 | WA |
Y | 2084N0400X | Neurologist | MD00024979 | WA |
NPI | 1558337493 |
---|---|
Provider Name | Michael K Koerner |
First Address | Everett, WA 98201-2723 |
Second Address | Everett, WA 98201-2723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 15/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1054626 | (05) | WA |
A06364 | (02) | |
A06364 | (02) | WA |