Healthcare Provider Details

I. General information

NPI: 1609413459
Provider Name (Legal Business Name): FLEUR THIEMKE MAK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2019
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 N WASHINGTON ST STE 200
SPOKANE WA
99201-2229
US

IV. Provider business mailing address

PO BOX 31001-4114
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-4200
  • Fax:
Mailing address:
  • Phone:
  • Fax: 509-747-6194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD.MD.70098976
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: