Individual
ILIANA DOMENICA MICALI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
7424 BRIDGEPORT WAY W STE 201, LAKEWOOD, WA 98499-8134
(253) 240-2110
(253) 240-2111
Mailing address
PO BOX 34703, SEATTLE, WA 98124-1703
(253) 681-6626
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD00037682
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0171332
LABOR & INDUSTRIES
WA
01
—
110229103
RAILROAD MEDICARE
—
01
—
2225134
AETNA HEALTH MANAGEMENT
WA
01
—
912006268
PREMERA
WA
01
—
912006268 98002 0000
TRICARE
WA
01
—
912006268 MI8274
REGENCE BLUESHIELD
WA
Enumeration date
07/16/2005
Last updated
01/15/2025
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