Provider Demographics
NPI:1750371878
Name:HOM, MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:HOM
Suffix:
Gender:M
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:PO BOX 5908
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-0408
Mailing Address - Country:US
Mailing Address - Phone:206-244-1212
Mailing Address - Fax:206-244-1223
Practice Address - Street 1:1100 PACIFIC AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4261
Practice Address - Country:US
Practice Address - Phone:206-244-1212
Practice Address - Fax:206-244-1223
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023238207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8931038OtherCRIME VICTIMS PROGRAM
WA0175854OtherDEPT OF LABOR & INDUSTRIE
WA5613HOOtherREGENCE BLUE SHIELD
WA1053263Medicaid
WA5613HOOtherREGENCE BLUE SHIELD
WAE33382Medicare UPIN
WA0175854OtherDEPT OF LABOR & INDUSTRIE