MEDICARE: ALISON S KNEISL MD

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	207Q00000X	Family Medicine Physician	MD00037623	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	US9649132	OTHER	WA	AETNA PCP PIN

General Provider Information

NPI Number	:	1578640108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON S KNEISL MD

Provider Business Mailing Address
First Line	:	210 9TH AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5120
Country	:	US
Telephone Number	:	206-224-1550
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 9TH AVE N
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98109-5120
Country	:	US
Telephone Number	:	206-224-1550
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	04/26/2021

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