Dr. Micah J. Mack DO
Internal Medicine Physician in Bellevue, WA(View on Map)
Full Name
Dr. Micah James Roland Mack DO
NPI Number
1447745450
NPI Type
Individual Provider
Gender
Male
Enumeration Date
06/22/2018
Specialties
(Taxonomies)Code
207R00000X
390200000X
Primary Taxonomy
Yes
No
Licenses
State
Washington
License Number
OP61175176
Contact
Information
Purpose
Mailing
Location
Address
11695 NE 4TH ST
11695 NE 4TH ST
City
Bellevue
Bellevue
State
WA
WA
Postal Code
98004-5268
98004-5268
Country
US
US
Telephone Number
(425) 637-1855
(425) 637-1855
Provider data last refreshed from NPPES NPI registry on 11/19/2024
Data last updated by provider on 11/16/2021
Provider Address
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