Provider Demographics
NPI:1144276759
Name:POLETTI, PIETRO M (MD)
Entity type:Individual
Prefix:
First Name:PIETRO
Middle Name:M
Last Name:POLETTI
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:PO BOX 1346
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1346
Mailing Address - Country:US
Mailing Address - Phone:206-743-4469
Mailing Address - Fax:425-212-1808
Practice Address - Street 1:9115 BRIDGEPORT WAY SW STE 1
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2449
Practice Address - Country:US
Practice Address - Phone:206-743-4469
Practice Address - Fax:425-212-1808
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000094242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA09174Medicare UPIN
WA12006001Medicare ID - Type UnspecifiedMEDICARE NUMBER