MEDICARE: KRIS V KOWDLEY 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	207RG0100X	Gastroenterology Physician	MD00030891	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2964	OTHER		INTERNAL ID-MOTOR VEHICLE ID
2	5475KO	OTHER	WA	BLUE SHIELD VM
3	US7218017	OTHER	WA	AETNA PCP PIN VM
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699850404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRIS V KOWDLEY MD

Provider Business Mailing Address
First Line	:	SWEDISH MEDICAL CENTER 1124 COLUMBIA ST STE 600
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98104-2046
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3216 NE 45TH PL STE 212
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-536-3030
Fax Number	:	206-524-0749

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	06/08/2020

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