Provider Demographics
NPI:1215295563
Name:PARK, SEA MI (MD ,PHD)
Entity type:Individual
Prefix:DR
First Name:SEA MI
Middle Name:
Last Name:PARK
Suffix:
Gender:
Credentials:MD ,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 LILLY RD NE STE 210
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-5101
Mailing Address - Country:US
Mailing Address - Phone:360-413-8550
Mailing Address - Fax:
Practice Address - Street 1:525 LILLY RD NE STE 210
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5101
Practice Address - Country:US
Practice Address - Phone:360-413-8550
Practice Address - Fax:360-413-8827
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD616409922084N0400X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology