Provider Demographics
NPI:1083909428
Name:KAUFFMAN, MICHELLE ANGELIKA (DO)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ANGELIKA
Last Name:KAUFFMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:ANGELIKA
Other - Last Name:WHITLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5708 E LAKE SAMMAMISH PKWY SE STE 102
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-8942
Mailing Address - Country:US
Mailing Address - Phone:425-688-5488
Mailing Address - Fax:425-233-6869
Practice Address - Street 1:5708 E LAKE SAMMAMISH PKWY SE STE 102
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-8942
Practice Address - Country:US
Practice Address - Phone:425-688-5488
Practice Address - Fax:425-233-6869
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP60454388207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZR1919OtherRESIDENCY TRAINING PERMIT NUMBER