Healthcare Provider Details

I. General information

NPI: 1346298643
Provider Name (Legal Business Name): KATHLEEN E GRAUNKE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 E GREENLAKE WAY N #200
SEATTLE WA
98115
US

IV. Provider business mailing address

6800 E GREENLAKE WAY N #200
SEATTLE WA
98115
US

V. Phone/Fax

Practice location:
  • Phone: 206-524-5656
  • Fax: 206-524-2841
Mailing address:
  • Phone: 206-524-5656
  • Fax: 206-524-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD00027636
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: