Healthcare Provider Details

I. General information

NPI: 1619061389
Provider Name (Legal Business Name): MICHAEL M. MCCARTHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 W 8TH AVE SUITE 660E
SPOKANE WA
99204-2302
US

IV. Provider business mailing address

PO BOX 421
LIBERTY LAKE WA
99019-0421
US

V. Phone/Fax

Practice location:
  • Phone: 509-474-6960
  • Fax: 509-227-7070
Mailing address:
  • Phone: 866-747-2455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberMD00019575
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMD00019575
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: