Healthcare Provider Details

I. General information

NPI: 1710056239
Provider Name (Legal Business Name): MICHAEL S OPSAHL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 10/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12039 NE 128TH ST SUITE 110
KIRKLAND WA
98034-3030
US

IV. Provider business mailing address

12039 NE 128TH ST SUITE 110
KIRKLAND WA
98034-3030
US

V. Phone/Fax

Practice location:
  • Phone: 425-822-7662
  • Fax: 425-822-0172
Mailing address:
  • Phone: 425-822-7662
  • Fax: 425-822-0172

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberMD00043913
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: