Healthcare Provider Details

I. General information

NPI: 1023081163
Provider Name (Legal Business Name): LANIE BELIC M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2202 S CEDAR ST STE. 310
TACOMA WA
98405-2318
US

IV. Provider business mailing address

PO BOX 1241
TACOMA WA
98401-1241
US

V. Phone/Fax

Practice location:
  • Phone: 253-272-8148
  • Fax: 253-404-0506
Mailing address:
  • Phone: 253-272-8148
  • Fax: 253-404-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD00015885
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: