Provider Demographics
NPI:1194804161
Name:JANSSEN, MICHAEL ERIC (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ERIC
Last Name:JANSSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-233-7489
Practice Address - Street 1:5350 TALLMAN AVE NW
Practice Address - Street 2:SUITE 301
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-5902
Practice Address - Country:US
Practice Address - Phone:206-320-3335
Practice Address - Fax:206-320-8027
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NHRT-1351207R00000X
WYTL1017207R00000X
NH13498207R00000X
WAMD60344899207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY1194804161Medicaid
WY22123Medicare PIN