Provider Demographics
NPI:1255811048
Name:MIKKI SEAGREN PLLC
Entity type:Organization
Organization Name:MIKKI SEAGREN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:425-241-6632
Mailing Address - Street 1:10900 NE 4TH ST
Mailing Address - Street 2:STE 2300
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-5882
Mailing Address - Country:US
Mailing Address - Phone:206-701-5600
Mailing Address - Fax:
Practice Address - Street 1:1370 116TH AVE NE STE 106
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3831
Practice Address - Country:US
Practice Address - Phone:425-658-2525
Practice Address - Fax:646-780-7951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty