Provider Demographics
NPI:1417911165
Name:CODSI, MICHAEL J (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:CODSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12039 NE 128TH STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034
Mailing Address - Country:US
Mailing Address - Phone:425-899-4810
Mailing Address - Fax:425-899-4811
Practice Address - Street 1:12333 NE 130TH LN
Practice Address - Street 2:SUITE 410
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7467
Practice Address - Country:US
Practice Address - Phone:425-899-4810
Practice Address - Fax:425-899-4811
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00047920207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1044120Medicaid
WA1044120Medicaid
8867068Medicare PIN