MEDICARE: MYKOL RADZISZEWSKI L.AC., EAMP

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	171100000X	Acupuncturist	AC 60182088	WA

General Provider Information

NPI Number	:	1134410483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYKOL RADZISZEWSKI L.AC., EAMP

Provider Business Mailing Address
First Line	:	6715 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5225
Country	:	US
Telephone Number	:	206-251-7109
Fax Number	:

Provider Business Practice Location Address
First Line	:	6715 GREENWOOD AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98103-5225
Country	:	US
Telephone Number	:	206-251-7109
Fax Number	:

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

Provider Enumeration Date	:	04/20/2011
Last Update Date	:	09/27/2012

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Directions to “ MYKOL RADZISZEWSKI L.AC., EAMP” Practice Location

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