Basic Information
| Provider Information | |||||||||
| NPI: | 1124009055 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE HAAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2304 HUGHES AVE SW | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981161836 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2069381419 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16251 SYLVESTER RD SW | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062441212 | ||||||||
| FaxNumber: | 2062441223 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2005 | ||||||||
| LastUpdateDate: | 03/26/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | MD00025426 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 0165305 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 1053479 | 05 | WA | MEDICAID | 5628DE | 01 | WA | REGENCE BLUE SHIELD | OTHER | 8934230 | 01 | WA | CRIME VICTIMS PGM | OTHER |