Healthcare Provider Details

I. General information

NPI: 1609442672
Provider Name (Legal Business Name): ANDREW KUGELMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2021
Last Update Date: 06/29/2024
Certification Date: 11/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

IV. Provider business mailing address

4800 SAND POINT WAY NE # OC.7830
SEATTLE WA
98105-3901
US

V. Phone/Fax

Practice location:
  • Phone: 206-987-2525
  • Fax:
Mailing address:
  • Phone: 206-987-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38270
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberML61548659
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: