Healthcare Provider Details

I. General information

NPI: 1720173040
Provider Name (Legal Business Name): LAKEVIEW FAMILY MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 NE 45TH PL STE 106
SEATTLE WA
98105-4028
US

IV. Provider business mailing address

3216 NE 45TH PL STE 106
SEATTLE WA
98105-4028
US

V. Phone/Fax

Practice location:
  • Phone: 206-526-0210
  • Fax: 206-526-0221
Mailing address:
  • Phone: 206-526-0210
  • Fax: 206-526-0221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number
License Number State

VIII. Authorized Official

Name: DR. MINDY L BLASKI
Title or Position: PRESIDENT
Credential: MD
Phone: 206-526-0210