Provider Demographics
NPI:1699759662
Name:STORCK, MICHAEL GUY (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GUY
Last Name:STORCK
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 1:5756 29TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5522
Mailing Address - Country:US
Mailing Address - Phone:206-526-8833
Mailing Address - Fax:
Practice Address - Street 1:8805 STEILACOOM BLVD SW
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98498-4770
Practice Address - Country:US
Practice Address - Phone:253-756-2397
Practice Address - Fax:253-756-3911
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000263762084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8134314Medicaid
WAF19161Medicare UPIN