MEDICARE: ALISA J. BLITZ-SEIBERT 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	207Q00000X	Family Medicine Physician	MD00045992	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	:	1770630535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISA J. BLITZ-SEIBERT M.D.

Provider Business Mailing Address
First Line	:	1100 WHEATON WAY
Second Line	:	SUITE F&G
City	:	BREMERTON
State	:	WA
Zip	:	98310-4459
Country	:	US
Telephone Number	:	360-621-2696
Fax Number	:	844-602-4646

Provider Business Practice Location Address
First Line	:	8042 NW WILDCAT LAKE RD
Second Line	:
City	:	BREMERTON
State	:	WA
Zip	:	98312-9571
Country	:	US
Telephone Number	:	360-204-4054
Fax Number	:

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

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	02/13/2017

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