Healthcare Provider Details

I. General information

NPI: 1598407728
Provider Name (Legal Business Name): MICHAEL E STUART MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6831 31ST AVE NE
SEATTLE WA
98115-7244
US

IV. Provider business mailing address

6831 31ST AVE NE
SEATTLE WA
98115-7244
US

V. Phone/Fax

Practice location:
  • Phone: 206-527-6146
  • Fax:
Mailing address:
  • Phone: 206-854-3680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number00012795
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: