Individual
DR. DAYNE TIMOTHY MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3101 NORTHUP WAY STE 201, BELLEVUE, WA 98004-1435
(425) 455-3600
(425) 455-3920
Mailing address
510 8TH AVE NE STE 320, ISSAQUAH, WA 98029-5436
(425) 507-0733
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD60476167
WA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD60476167
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2018712
—
WA
Enumeration date
03/26/2011
Last updated
05/23/2024
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