Provider Demographics
NPI:1740348515
Name:KAZARAS, MICHAEL PETER (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:PETER
Last Name:KAZARAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10525 NE 136TH PL
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-2021
Mailing Address - Country:US
Mailing Address - Phone:425-820-5287
Mailing Address - Fax:
Practice Address - Street 1:10126 NE 132ND ST
Practice Address - Street 2:SUITE A
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-9043
Practice Address - Country:US
Practice Address - Phone:425-899-1234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA13588208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1066166Medicaid
WA1066166Medicaid