Provider Demographics
NPI:1831520196
Name:GINSBERG, MICHAEL LEWIS (LMP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEWIS
Last Name:GINSBERG
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:LEWIS
Other - Last Name:GINSBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMP
Mailing Address - Street 1:202 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-6214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22647 NE INGLEWOOD HILL RD
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-7105
Practice Address - Country:US
Practice Address - Phone:480-385-9172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60417769171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor