Provider Demographics
NPI:1982884920
Name:DR MIKE, PLLC
Entity Type:Organization
Organization Name:DR MIKE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SCHIESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-401-1651
Mailing Address - Street 1:1540 140TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-4516
Mailing Address - Country:US
Mailing Address - Phone:425-644-6048
Mailing Address - Fax:
Practice Address - Street 1:1540 140TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4516
Practice Address - Country:US
Practice Address - Phone:425-644-6048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD34336207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59539Medicare UPIN