Provider Demographics
NPI:1922384411
Name:KOELEMAY, KATHRYN GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:GAIL
Last Name:KOELEMAY
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 1:851 80TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-4743
Mailing Address - Country:US
Mailing Address - Phone:206-263-8188
Mailing Address - Fax:
Practice Address - Street 1:401 5TH AVE STE 900
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-1818
Practice Address - Country:US
Practice Address - Phone:206-263-8188
Practice Address - Fax:206-296-4803
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 00028389208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics