Healthcare Provider Details

I. General information

NPI: 1376802025
Provider Name (Legal Business Name): EDWARD KELLY STEVEN MRACHEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2012
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13103 E MANSFIELD AVE
SPOKANE VALLEY WA
99216-1642
US

IV. Provider business mailing address

9000 W WISCONSIN AVE
MILWAUKEE WI
53226-4874
US

V. Phone/Fax

Practice location:
  • Phone: 509-753-7222
  • Fax:
Mailing address:
  • Phone: 414-266-2526
  • Fax: 414-266-2779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZN0500X
TaxonomyNeuropathology Physician
License NumberMD70095044
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number81067
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMD70095044
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207ZP0213X
TaxonomyPediatric Pathology Physician
License NumberMD70095044
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: