Provider Demographics
NPI:1912087982
Name:FIALKOW, MICHAEL FREDERICK (MD MPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FREDERICK
Last Name:FIALKOW
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356460
Mailing Address - Street 2:1959 NE PACIFIC
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98195-6460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1959 NE PACIFIC ST
Practice Address - Street 2:DEPARTMENT OF OBSTETRICS & GYNECOLOGY
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6460
Practice Address - Country:US
Practice Address - Phone:206-598-5960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2013-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00038082207V00000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
168990OtherINTERNAL ID-MOTOR VEHICLE ID
WA8285520Medicaid
WA8285520Medicaid
H41467Medicare UPIN