Provider Demographics
NPI:1184700981
Name:KUECHLE, MELANIE K (MD)
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:K
Last Name:KUECHLE
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 1:21727 76TH AVE W
Mailing Address - Street 2:STE H
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7549
Mailing Address - Country:US
Mailing Address - Phone:425-672-1333
Mailing Address - Fax:425-672-7755
Practice Address - Street 1:21727 76TH AVE W
Practice Address - Street 2:STE H
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026
Practice Address - Country:US
Practice Address - Phone:425-672-1333
Practice Address - Fax:425-672-7755
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00032948207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00749094OtherMEDICARE PTAN
WA8182164Medicaid
4343OtherINTERNAL ID-MOTOR VEHICLE ID
WA8182164Medicaid