Provider Demographics
NPI:1457446379
Name:KITCHELL, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:KITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1124 COLUMBIA ST
Mailing Address - Street 2:620
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2026
Mailing Address - Country:US
Mailing Address - Phone:206-215-2550
Mailing Address - Fax:206-215-2555
Practice Address - Street 1:1124 COLUMBIA ST
Practice Address - Street 2:620
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2026
Practice Address - Country:US
Practice Address - Phone:206-215-2550
Practice Address - Fax:206-215-2555
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1010982Medicaid
A06112Medicare UPIN
WA1010982Medicaid