Provider Demographics
NPI:1962685222
Name:LARSEN, MICHAEL CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CARL
Last Name:LARSEN
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 1:1100 9TH AVE
Mailing Address - Street 2:MS:M4-PFS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2756
Mailing Address - Country:US
Mailing Address - Phone:206-515-5811
Mailing Address - Fax:
Practice Address - Street 1:1100 9TH AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2756
Practice Address - Country:US
Practice Address - Phone:206-223-2319
Practice Address - Fax:206-223-6379
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97376207R00000X
WAMD60295858207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD00307OtherAK MEDICAID
WA0299294OtherLABOR AND INDUSTRY
WA1962685222OtherMONTANA MEDICAID
WA1962685222Medicaid
WA8912205Medicare PIN
WA1962685222OtherMONTANA MEDICAID
WAP01121119Medicare PIN