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General NPI Number Information
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NPI Number | 1649454026
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Entity Type | Organization
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Legal Business Name | MICHAEL L. TJOELKER, M.D.
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Dates
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Enumeration Date | 12/20/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 3327 COLBY AVE
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City | EVERETT
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State | WA
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Zip | 98201-6403
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Country | US
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Telephone | 425-259-0049
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Fax | 425-258-6403
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Provider Business Mailing Address
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Address Line | 3327 COLBY AVE
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City | EVERETT
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State | WA
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Zip | 98201-6403
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Country | US
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Telephone | 425-259-0049
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Fax | 425-258-6403
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL LYLE TJOELKER
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Credential | M.D.
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Telephone | 425-259-0049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | MD00022643
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License Number State | WA
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