Provider Demographics
NPI:1659541449
Name:SIRKIS, HARTLEY MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:HARTLEY
Middle Name:MICHAEL
Last Name:SIRKIS
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2008-03-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2391852085R0202X
WAMD606946212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0364006OtherL&I EVERGREEN RADIA
WA0364004OtherL&I RADIA-KING COUNTY
WA2068675Medicaid
WA0364003OtherL&I RADIA-REST OF WA
WA0364005OtherL&I SWEDISH RADIA EDMONDS
WAG8959824Medicare PIN
WAP01766729Medicare PIN
WA0364005OtherL&I SWEDISH RADIA EDMONDS
WAP01766482Medicare PIN
WAG8959823Medicare PIN
WA0364003OtherL&I RADIA-REST OF WA
WA2068675Medicaid