Healthcare Provider Details

I. General information

NPI: 1023151081
Provider Name (Legal Business Name): MICHAEL CORSILLES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 09/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8639 36TH AVE SW
SEATTLE WA
98126-3609
US

IV. Provider business mailing address

2100 116TH AVE NE
BELLEVUE WA
98004-3016
US

V. Phone/Fax

Practice location:
  • Phone: 206-380-5202
  • Fax:
Mailing address:
  • Phone: 425-467-1314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60191026
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License NumberNT00001187
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: