Provider Demographics
NPI:1700978160
Name:PIETRO, MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:PIETRO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3015 SQUALICUM PKWY
Mailing Address - Street 2:SUITE #250
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1945
Mailing Address - Country:US
Mailing Address - Phone:360-738-0568
Mailing Address - Fax:360-647-5264
Practice Address - Street 1:2979 SQUALICUM PKWY STE 303
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1811
Practice Address - Country:US
Practice Address - Phone:360-788-8200
Practice Address - Fax:360-788-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2023-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00023940208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1069749Medicaid
WAE96868Medicare UPIN
WA1069749Medicaid