Provider Demographics
NPI:1851557862
Name:TYLEE, TRACY SUSAN (MD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:SUSAN
Last Name:TYLEE
Suffix:
Gender:F
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:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-543-6420
Mailing Address - Fax:
Practice Address - Street 1:4225 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6099
Practice Address - Country:US
Practice Address - Phone:206-598-4882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60171767207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0294747OtherL&I
WA1851557862Medicaid