Healthcare Provider Details

I. General information

NPI: 1598877565
Provider Name (Legal Business Name): MICHAEL CHARLES PREVITI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3915 TALBOT RD S STE 104
RENTON WA
98055-5738
US

IV. Provider business mailing address

PO BOX 34876
SEATTLE WA
98124-1876
US

V. Phone/Fax

Practice location:
  • Phone: 425-656-5566
  • Fax: 425-656-5567
Mailing address:
  • Phone: 425-656-5412
  • Fax: 425-656-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberMD60295988
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD60295988
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: