Provider Demographics
NPI:1477630051
Name:ARNTZEN, KELLI RENAE (MD)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:RENAE
Last Name:ARNTZEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4740 44TH AVE SW
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-4402
Mailing Address - Country:US
Mailing Address - Phone:206-937-8954
Mailing Address - Fax:206-937-1916
Practice Address - Street 1:4740 44TH AVE SW
Practice Address - Street 2:SUITE 200
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98116-4402
Practice Address - Country:US
Practice Address - Phone:206-937-8954
Practice Address - Fax:206-937-1916
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027207207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE72418Medicare UPIN
WAGAB40331Medicare PIN