Provider Demographics
NPI:1326056771
Name:KADEG, LARRY J (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:J
Last Name:KADEG
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 1:25246 NETWORK PL
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-1252
Mailing Address - Country:US
Mailing Address - Phone:425-656-4255
Mailing Address - Fax:425-656-4003
Practice Address - Street 1:400 S 43RD ST
Practice Address - Street 2:ER DEPT
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5714
Practice Address - Country:US
Practice Address - Phone:425-228-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020881207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003235Medicaid
WA185271OtherLABOR&INDUSTRIES PROV#
WAKA2130OtherREGENCE BS PROV #
WA000106719Medicare ID - Type UnspecifiedMEDICARE PART B PROV #
WA1003235Medicaid