Provider Demographics
NPI:1528131083
Name:YAKOVLEVITCH, MARKO (MD)
Entity type:Individual
Prefix:
First Name:MARKO
Middle Name:
Last Name:YAKOVLEVITCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 84026
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-8426
Mailing Address - Country:US
Mailing Address - Phone:206-525-2723
Mailing Address - Fax:
Practice Address - Street 1:1536 N 115TH ST STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8400
Practice Address - Country:US
Practice Address - Phone:206-363-1004
Practice Address - Fax:206-363-3548
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029941207RC0000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1097542Medicaid
WA1097542Medicaid
WA8800567Medicare PIN