Basic Information
| Provider Information | |||||||||
| NPI: | 1730422890 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ACTIS | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | UNIVERSITY OF WASHINGTON, BOX 356540 | ||||||||
| Address2: | 1959 NE PACIFIC STREET, BB-1469 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981957429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065432673 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1959 NE PACIFIC STREET, BB-1469 | ||||||||
| Address2: | BOX 356540 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98195 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2065432470 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2013 | ||||||||
| LastUpdateDate: | 07/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | ML 60361940 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.