Provider Demographics
NPI:1073606331
Name:RAKITA, ROBERT M (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:RAKITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6175
Practice Address - Country:US
Practice Address - Phone:206-598-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021846207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD5603WMedicaid
WAUS2102745OtherAETNA SPECIALIST PIN
WA1073606331Medicaid
WA440003437OtherRAILROAD MEDICARE
WA0039574OtherLABOR AND INDUSTRIES #
WA0251908OtherL & I
WARA6342OtherBLUE SHIELD #
WAUS2102745OtherAETNA SPECIALIST PIN
AKMD5603WMedicaid
WA8850262Medicare PIN
WAAB09664Medicare PIN