Provider Demographics
NPI:1518095587
Name:EULBERG, MICHAEL D
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:EULBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34036
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1036
Mailing Address - Country:US
Mailing Address - Phone:425-899-3292
Mailing Address - Fax:425-899-3269
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:SUITE G105
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-899-6972
Practice Address - Fax:425-899-6970
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00021703207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA03147OtherLABOR AND INDUSTRIES
WA905045OtherPREMERA BLUE CROSS
WAE740OtherREGENCE BLUE SHIELD
WA1293604Medicaid
WA4079690OtherAETNA
WA03147OtherLABOR AND INDUSTRIES
WA905045OtherPREMERA BLUE CROSS
WA4079690OtherAETNA