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General NPI Number Information
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NPI Number | 1134128788
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Entity Type | Individual
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Provider Name | ILIANA DOMENICA MICALI M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/16/2005
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 7424 BRIDGEPORT WAY W STE 201
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City | LAKEWOOD
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State | WA
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Zip | 98499-8134
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Country | US
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Telephone | 253-240-2110
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Fax | 253-240-2111
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Provider Business Mailing Address
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Address Line | PO BOX 34703
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City | SEATTLE
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State | WA
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Zip | 98124-1703
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Country | US
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Telephone | 253-681-6626
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD00037682
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License Number State | WA
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