MEDICARE: LAKEVIEW FAMILY MEDICINE, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	173000000X	Legal Medicine

General Provider Information

NPI Number	:	1720173040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAKEVIEW FAMILY MEDICINE, PLLC

Provider Business Mailing Address
First Line	:	3216 NE 45TH PL STE 106
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-526-0210
Fax Number	:	206-526-0221

Provider Business Practice Location Address
First Line	:	3216 NE 45TH PL STE 106
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98105-4028
Country	:	US
Telephone Number	:	206-526-0210
Fax Number	:	206-526-0221

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MINDY L BLASKI
Credential	:	MD
Telephone Number	:	206-526-0210

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	08/22/2020

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