Provider Demographics
NPI:1467612077
Name:VELGUTH, KURT (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:VELGUTH
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 1:333 108TH AVE NE
Mailing Address - Street 2:SUITE M150
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5703
Mailing Address - Country:US
Mailing Address - Phone:425-454-3300
Mailing Address - Fax:
Practice Address - Street 1:333 108TH AVE NE
Practice Address - Street 2:SUITE M150
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5703
Practice Address - Country:US
Practice Address - Phone:425-454-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL3222207Q00000X
MA236319390200000X
WA60373796207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program