Individual
MICHAEL J. PICCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2320 FREEWAY DRIVE, MOUNT VERNON, WA 98237
(360) 814-6800
(360) 814-6917
Mailing address
1400 E KINCAID ST, ATTN: CREDENTIALING, MOUNT VERNON, WA 98274-4127
(360) 428-2500
(360) 428-6485
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
OP00002317
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1088445
—
WA
01
—
341377
LABOR & INDUSTRIES
WA
Enumeration date
11/29/2007
Last updated
08/13/2015
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