MEDICARE: MIKAEL KAUTSKY D D S P S

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	332B00000X	Durable Medical Equipment & Medical Supplies	DE 00007768	WA

General Provider Information

NPI Number	:	1538567953
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIKAEL KAUTSKY D D S P S

Provider Business Mailing Address
First Line	:	1100 EASTSIDE ST SE # 4
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-7304
Country	:	US
Telephone Number	:	360-943-6378
Fax Number	:	360-705-3159

Provider Business Practice Location Address
First Line	:	1100 EASTSIDE ST SE # 4
Second Line	:
City	:	OLYMPIA
State	:	WA
Zip	:	98501-7304
Country	:	US
Telephone Number	:	360-943-6378
Fax Number	:	360-705-3159

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MIKAEL KAUTSKY
Credential	:
Telephone Number	:	360-943-6378

Provider Enumeration Date	:	12/17/2014
Last Update Date	:	12/17/2014

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