Individual
GREGORY ALEXANDER KICSKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1959 NE PACIFIC ST, SEATTLE, WA 98195-0001
(206) 598-6200
Mailing address
PO BOX 50095, SEATTLE, WA 98145-5095
(206) 543-6420
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
Primary
MD60079327
WA
2085R0202X
Diagnostic Radiology Physician
MD60079327
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0253628
L&I
WA
05
—
1134278138
—
WA
Enumeration date
01/09/2007
Last updated
12/24/2012
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