Provider Demographics
NPI:1649471889
Name:MICHAEL, ELLEN VIOLET (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:VIOLET
Last Name:MICHAEL
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 1:345 KNECHTEL WAY NE
Mailing Address - Street 2:STE. 102
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2860
Mailing Address - Country:US
Mailing Address - Phone:206-780-6779
Mailing Address - Fax:206-780-7923
Practice Address - Street 1:345 KNECHTEL WAY NE
Practice Address - Street 2:STE. 102
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2860
Practice Address - Country:US
Practice Address - Phone:206-780-6779
Practice Address - Fax:206-780-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000375452084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAE06910Medicare UPIN
WAAB33418Medicare ID - Type UnspecifiedMEDICARE ID NUMBER