Provider Demographics
NPI:1174619589
Name:COLKITT, MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:COLKITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10513 SILVERDALE WAY NW
Mailing Address - Street 2:STE 101
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98338
Mailing Address - Country:US
Mailing Address - Phone:360-692-1848
Mailing Address - Fax:360-692-1912
Practice Address - Street 1:10513 SILVERDALE WAY NW
Practice Address - Street 2:STE 101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98338
Practice Address - Country:US
Practice Address - Phone:360-692-1848
Practice Address - Fax:360-692-1912
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000306012083X0100X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA107562OtherL&I
WAMD00030601OtherSTATE LICENSE
WABC1751824OtherDEA
WAF12204Medicare UPIN