Provider Demographics
NPI:1356454003
Name:TURNER, MICHAEL KWAME (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KWAME
Last Name:TURNER
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 1:3321 MT ADAMS VIEW DR
Mailing Address - Street 2:
Mailing Address - City:WEST RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99353
Mailing Address - Country:US
Mailing Address - Phone:509-438-9561
Mailing Address - Fax:509-769-0944
Practice Address - Street 1:1350 N GRANT ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1355
Practice Address - Country:US
Practice Address - Phone:509-349-3010
Practice Address - Fax:509-769-0944
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60072206208100000X
WA600722062081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD60072206OtherSTATE LICENSE
WA0255541OtherDEPT LABOR & INDUSTRIES
WA8544710Medicaid
WA0255541OtherDEPT LABOR & INDUSTRIES