Healthcare Provider Details

I. General information

NPI: 1528179066
Provider Name (Legal Business Name): MICHAEL JOSHUA BISHOP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 05/02/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S COLUMBIAN WAY 112ANES
SEATTLE WA
98108-1532
US

IV. Provider business mailing address

1660 S COLUMBIAN WAY 112ANES
SEATTLE WA
98108-1532
US

V. Phone/Fax

Practice location:
  • Phone: 206-764-2157
  • Fax:
Mailing address:
  • Phone: 206-764-2157
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00017981
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD00017981
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: