Provider Demographics
NPI:1619934882
Name:MONSON, MIKALEL CHRISTIAN (MD)
Entity Type:Individual
Prefix:
First Name:MIKALEL
Middle Name:CHRISTIAN
Last Name:MONSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4011 TALBOT RD S
Mailing Address - Street 2:#210
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5773
Mailing Address - Country:US
Mailing Address - Phone:425-255-4250
Mailing Address - Fax:425-271-3294
Practice Address - Street 1:4011 TALBOT RD S
Practice Address - Street 2:#210
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5773
Practice Address - Country:US
Practice Address - Phone:425-255-4250
Practice Address - Fax:425-271-3294
Is Sole Proprietor?:No
Enumeration Date:2006-04-29
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00034143174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8196479Medicaid
F80894Medicare UPIN
WA8196479Medicaid