Provider Demographics
NPI:1578664892
Name:MICHEL, MARLON B (MD MBA)
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:B
Last Name:MICHEL
Suffix:
Gender:M
Credentials:MD MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20704 SNAG ISLAND DR E
Mailing Address - Street 2:
Mailing Address - City:LAKE TAPPS
Mailing Address - State:WA
Mailing Address - Zip Code:98391-8712
Mailing Address - Country:US
Mailing Address - Phone:206-499-6696
Mailing Address - Fax:
Practice Address - Street 1:20704 SNAG ISLAND DR E
Practice Address - Street 2:
Practice Address - City:LAKE TAPPS
Practice Address - State:WA
Practice Address - Zip Code:98391-8712
Practice Address - Country:US
Practice Address - Phone:206-499-6696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5685713-1205207L00000X
WAMD00044212207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT1502954OtherUMWA
UT2090168OtherUNITED HEALTHCARE
UTQM0000075886OtherALTIUS
AZ084958Medicaid
WY122721100Medicaid
UT2090168OtherUNITED HEALTHCARE