Provider Demographics
NPI:1558475202
Name:SWISTAK, MICHAEL A (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:A
Last Name:SWISTAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2701 1ST AVE
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121-1123
Mailing Address - Country:US
Mailing Address - Phone:206-448-2516
Mailing Address - Fax:206-448-6473
Practice Address - Street 1:1414 116TH AVE NE
Practice Address - Street 2:SUITE E
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:425-455-9555
Practice Address - Fax:425-454-2044
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2011-04-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026018207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0179877OtherL & I
WA1092345Medicaid
WA1092345Medicaid
WAD87210Medicare UPIN