Provider Demographics
NPI:1588600159
Name:MCKEVITT, SILVIA SPEIDEL (MD)
Entity type:Individual
Prefix:
First Name:SILVIA
Middle Name:SPEIDEL
Last Name:MCKEVITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:931 YAKIMA AVE S
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-3146
Mailing Address - Country:US
Mailing Address - Phone:206-370-1919
Mailing Address - Fax:
Practice Address - Street 1:4300 TALBOT RD S
Practice Address - Street 2:SUITE 311
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-6238
Practice Address - Country:US
Practice Address - Phone:206-728-8119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2012-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00046137207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200053230Medicaid
OK2445187021Medicare ID - Type Unspecified
OK200053230Medicaid