Healthcare Provider Details

I. General information

NPI: 1417911165
Provider Name (Legal Business Name): MICHAEL J. CODSI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 11/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12333 NE 130TH LN SUITE 410
KIRKLAND WA
98034-7467
US

IV. Provider business mailing address

12039 NE 128TH STREET SUITE 400
KIRKLAND WA
98034
US

V. Phone/Fax

Practice location:
  • Phone: 425-899-4810
  • Fax: 425-899-4811
Mailing address:
  • Phone: 425-899-4810
  • Fax: 425-899-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD00047920
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: