Provider Demographics
NPI:1942374095
Name:KULLNAT, MEGAN WILLS (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:WILLS
Last Name:KULLNAT
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 1:7530 164TH AVE. NE
Mailing Address - Street 2:SUITE #A215
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7530 164TH AVE. NE
Practice Address - Street 2:SUITE #A215
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052
Practice Address - Country:US
Practice Address - Phone:425-885-9292
Practice Address - Fax:425-885-9106
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHRT 1621208000000X
ORMD150695208000000X
WAMD 60217716208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics