Healthcare Provider Details

I. General information

NPI: 1588632491
Provider Name (Legal Business Name): MICHAEL ROHRENBACH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 106TH ST SW
MUKILTEO WA
98275-4700
US

IV. Provider business mailing address

3901 HOYT AVE
EVERETT WA
98201-4918
US

V. Phone/Fax

Practice location:
  • Phone: 425-493-6004
  • Fax:
Mailing address:
  • Phone: 425-258-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1366
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: