Individual
DR. MICAH JAMES ROLAND MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
11695 NE 4TH ST, BELLEVUE, WA 98004-5268
(425) 637-1855
(206) 344-7970
Mailing address
11695 NE 4TH ST, BELLEVUE, WA 98004-5268
(425) 637-1855
(206) 344-7970
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OP61175176
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/22/2018
Last updated
11/16/2021
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