Provider Demographics
NPI:1033254842
Name:BLADE, KRISTIE L (MD)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:L
Last Name:BLADE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 OLIVE WAY STE 401 # M4-PA
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1873
Mailing Address - Country:US
Mailing Address - Phone:206-583-6025
Mailing Address - Fax:
Practice Address - Street 1:19116 33RD AVE W
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4706
Practice Address - Country:US
Practice Address - Phone:425-771-7500
Practice Address - Fax:425-712-7903
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00042594207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8396079Medicaid
WAP00389474OtherRAILROAD MEDICARE
WA8864203Medicare PIN
WAP00389474OtherRAILROAD MEDICARE
WAG8922875Medicare PIN