Provider Demographics
NPI:1235125188
Name:MICKEY, AILEEN ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:AILEEN
Middle Name:ANN
Last Name:MICKEY
Suffix:
Gender:F
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 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-6972
Mailing Address - Fax:425-899-6970
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:EVERGREEN PULMONARY CARE CENTER, SUITE G-105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-899-6972
Practice Address - Fax:425-899-6970
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60074650207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3145883Medicaid
WA8550485Medicaid
NJ3145883Medicaid
NJA20740Medicare ID - Type Unspecified
WAG8884116Medicare PIN