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General NPI Number Information
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NPI Number | 1790914141
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Entity Type | Individual
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Provider Name | NEETI MUKESH KANODRA MD
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Gender | Female
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 09/27/2023
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Provider Practice Location Address
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Address Line | 515 MINOR AVE STE 300
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City | SEATTLE
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State | WA
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Zip | 98104-2133
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Country | US
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Telephone | 206-320-6500
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Fax | 206-386-9648
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Provider Business Mailing Address
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Address Line | PO BOX 25608
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City | SALT LAKE CITY
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State | UT
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Zip | 84125-0608
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Country | US
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Telephone | 206-320-4476
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Fax | 206-568-7043
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number | MD60605112
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | MD60605112
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License Number State | WA
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