Individual
DR. VITALI G MIRONOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
747 BROADWAY, SEATTLE, WA 98122-4379
(206) 215-2520
(206) 386-3180
Mailing address
PO BOX 25608, SALT LAKE CITY, UT 84125-0608
(206) 320-4476
(206) 568-7043
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD00040662
WA
208M00000X
Hospitalist Physician
Primary
MD00040662
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0202972
LABOR AND INDUSTRIES
WA
05
—
1881756039
—
WA
Enumeration date
12/14/2006
Last updated
09/26/2023
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