Provider Demographics
NPI:1699025205
Name:NORTH KITSAP EAR NOSE & THROAT CLINIC
Entity Type:Organization
Organization Name:NORTH KITSAP EAR NOSE & THROAT CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:JUNGKEIT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-697-1414
Mailing Address - Street 1:22180 OLYMPIC COLLEGE WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-6664
Mailing Address - Country:US
Mailing Address - Phone:360-697-1414
Mailing Address - Fax:360-697-3939
Practice Address - Street 1:22180 OLYMPIC COLLEGE WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-6664
Practice Address - Country:US
Practice Address - Phone:360-697-1414
Practice Address - Fax:360-697-3939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWD00033350207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty