MEDICARE: GANDIS G. MAZEIKA M.D.

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	174400000X	Specialist	MD00038659	WA
2	2084S0012X	Sleep Medicine (Psychiatry & Neurology) Physician	MD00038659	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679518880
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GANDIS G. MAZEIKA M.D.

Provider Business Mailing Address
First Line	:	16150 NE 85TH ST STE 203
Second Line	:
City	:	REDMOND
State	:	WA
Zip	:	98052-3543
Country	:	US
Telephone Number	:	206-427-4242
Fax Number	:	425-636-2401

Provider Business Practice Location Address
First Line	:	21701 76TH AVE W STE 206
Second Line	:
City	:	EDMONDS
State	:	WA
Zip	:	98026-7536
Country	:	US
Telephone Number	:	425-636-2400
Fax Number	:	425-636-2401

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	10/12/2022

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