Healthcare Provider Details

I. General information

NPI: 1982783643
Provider Name (Legal Business Name): MICHAEL SEAN KINCAID
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12040 NE 128TH ST
KIRKLAND WA
98034-3013
US

IV. Provider business mailing address

PO BOX 24503
SEATTLE WA
98124-0503
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-2560
  • Fax: 425-899-2079
Mailing address:
  • Phone: 425-407-1500
  • Fax: 425-407-1112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00044248
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberMD00044248
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: