Basic Information
| Provider Information | |||||||||
| NPI: | 1982783643 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KINCAID | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SEAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 24503 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981240503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254071500 | ||||||||
| FaxNumber: | 4254071112 | ||||||||
| Practice Location | |||||||||
| Address1: | 12040 NE 128TH ST | ||||||||
| Address2: | |||||||||
| City: | KIRKLAND | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980343013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4258992560 | ||||||||
| FaxNumber: | 4258992079 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/03/2006 | ||||||||
| LastUpdateDate: | 06/27/2011 | ||||||||
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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 | MD00044248 | WA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207RC0200X | MD00044248 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 263020 | 01 | INTERNAL ID-MOTOR VEHICLE ID | OTHER |