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General NPI Number Information
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NPI Number | 1720225592
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Entity Type | Individual
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Provider Name | MIKE MCCANN LMP
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Gender | Male
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Dates
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Enumeration Date | 01/14/2009
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Last Update Date | 01/14/2009
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Provider Practice Location Address
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Address Line | 9250 45TH AVE SW
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City | SEATTLE
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State | WA
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Zip | 98136-2633
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Country | US
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Telephone | 206-937-4140
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Fax |
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Provider Business Mailing Address
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Address Line | 2131 ARCH PL SW
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City | SEATTLE
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State | WA
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Zip | 98116-2032
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Country | US
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Telephone | 206-683-1175
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | MA00007332
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License Number State | WA
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