Provider Demographics
NPI:1659392090
Name:KRISEMAN, JAMES D (DO)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:D
Last Name:KRISEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3947
Mailing Address - Street 2:MS 315010
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-3947
Mailing Address - Country:US
Mailing Address - Phone:425-688-5670
Mailing Address - Fax:425-453-5139
Practice Address - Street 1:16315 NE 74TH ST
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7800
Practice Address - Country:US
Practice Address - Phone:425-435-6430
Practice Address - Fax:425-635-6431
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOS6356207Q00000X
WAOP60089222207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL274573900Medicaid
WA2021584Medicaid
WA298779OtherLABOR AND INDUSTRIES
WA8911345Medicare PIN
WA298779OtherLABOR AND INDUSTRIES
FL80904Medicare PIN