Provider Demographics
NPI:1619905627
Name:CHAPKO, KEVIN M
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
Last Name:CHAPKO
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 1:600 BROADWAY
Mailing Address - Street 2:STE 270
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5392
Mailing Address - Country:US
Mailing Address - Phone:206-381-0269
Mailing Address - Fax:206-829-2083
Practice Address - Street 1:1321 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1665
Practice Address - Country:US
Practice Address - Phone:425-258-3678
Practice Address - Fax:425-258-3048
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000019101207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
189628OtherL & I
WA8378572Medicaid
9678CHOtherB/S REGENCE 90
WA8378572Medicaid
H92449Medicare UPIN