Healthcare Provider Details

I. General information

NPI: 1558337493
Provider Name (Legal Business Name): MICHAEL K KOERNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2326 RUCKER AVENUE
EVERETT WA
98201-2723
US

IV. Provider business mailing address

2326 RUCKER AVENUE
EVERETT WA
98201-2723
US

V. Phone/Fax

Practice location:
  • Phone: 425-259-5121
  • Fax: 425-339-8517
Mailing address:
  • Phone: 425-259-5121
  • Fax: 425-339-8517

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number00024979
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00024979
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: