Provider Demographics
NPI:1699850404
Name:KOWDLEY, KRIS V (MD)
Entity type:Individual
Prefix:
First Name:KRIS
Middle Name:V
Last Name:KOWDLEY
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:SWEDISH MEDICAL CENTER 1124 COLUMBIA ST STE 600
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-2046
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3216 NE 45TH PL STE 212
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4028
Practice Address - Country:US
Practice Address - Phone:206-536-3030
Practice Address - Fax:206-524-0749
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030891207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
2964OtherINTERNAL ID-MOTOR VEHICLE ID
WA5475KOOtherBLUE SHIELD VM
WAUS7218017OtherAETNA PCP PIN VM
WA8149411Medicaid
WAUS7218017OtherAETNA PCP PIN VM
2964OtherINTERNAL ID-MOTOR VEHICLE ID
WA5475KOOtherBLUE SHIELD VM
107908Medicare ID - Type Unspecified
WA8149411Medicaid