Provider Demographics
NPI:1013091164
Name:MACKENSEN, GEORG BURKHARD (M D, PHD)
Entity type:Individual
Prefix:PROF
First Name:GEORG
Middle Name:BURKHARD
Last Name:MACKENSEN
Suffix:
Gender:M
Credentials:M D, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1959 NE PACIFIC ST
Mailing Address - Street 2:SS327F
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-0001
Mailing Address - Country:US
Mailing Address - Phone:206-598-1462
Mailing Address - Fax:206-598-8269
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:SS327F
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-0001
Practice Address - Country:US
Practice Address - Phone:206-598-1462
Practice Address - Fax:206-598-8269
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC98-01573207L00000X
WATR60264609207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2275644Medicare ID - Type Unspecified
G98786Medicare ID - Type Unspecified
NC891212HMedicare ID - Type Unspecified