Provider Demographics
NPI:1760506711
Name:TASCH, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:TASCH
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 1:2015 116TH AVE NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3018
Mailing Address - Country:US
Mailing Address - Phone:425-453-8406
Mailing Address - Fax:425-453-4173
Practice Address - Street 1:2015 116TH AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3018
Practice Address - Country:US
Practice Address - Phone:425-453-8406
Practice Address - Fax:425-453-4173
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043894207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8513814Medicaid
WA8873873Medicare PIN