MEDICARE: MR. MICHAEL CORSILLES PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175F00000X	Naturopath	NT00001187	WA
2	363A00000X	Physician Assistant	PA60191026	WA

General Provider Information

NPI Number	:	1023151081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL CORSILLES PA-C

Provider Business Mailing Address
First Line	:	2100 116TH AVE NE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3016
Country	:	US
Telephone Number	:	425-467-1314
Fax Number	:

Provider Business Practice Location Address
First Line	:	8639 36TH AVE SW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98126-3609
Country	:	US
Telephone Number	:	206-380-5202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2007
Last Update Date	:	09/06/2018

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