Healthcare Provider Details

I. General information

NPI: 1023085248
Provider Name (Legal Business Name): KATHLEEN MAKIELSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 7TH AVE
SEATTLE WA
98104-1132
US

IV. Provider business mailing address

904 7TH AVE
SEATTLE WA
98104-1132
US

V. Phone/Fax

Practice location:
  • Phone: 206-329-1760
  • Fax:
Mailing address:
  • Phone: 206-329-1760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD00023108
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: