Provider Demographics
NPI:1538567953
Name:MIKAEL KAUTSKY D D S P S
Entity type:Organization
Organization Name:MIKAEL KAUTSKY D D S P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAUTSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-943-6378
Mailing Address - Street 1:1100 EASTSIDE ST SE # 4
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-7304
Mailing Address - Country:US
Mailing Address - Phone:360-943-6378
Mailing Address - Fax:360-705-3159
Practice Address - Street 1:1100 EASTSIDE ST SE # 4
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98501-7304
Practice Address - Country:US
Practice Address - Phone:360-943-6378
Practice Address - Fax:360-705-3159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE 00007768332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies