Provider Demographics
NPI:1376571083
Name:KAMINSKI, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:KAMINSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3600 LIND AVE SW
Mailing Address - Street 2:SUITE 100 ATTN CREDENTIALING
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4970
Mailing Address - Country:US
Mailing Address - Phone:425-690-2715
Mailing Address - Fax:
Practice Address - Street 1:14410 SE PETROVITSKY RD
Practice Address - Street 2:STE 104
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98058-8900
Practice Address - Country:US
Practice Address - Phone:425-690-3405
Practice Address - Fax:425-690-9405
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00018335207QA0505X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8891710OtherMEDICARE - VALLEY MEDICAL GROUP
WA1043930Medicaid
WA1064161Medicaid