Provider Demographics
NPI:1174631683
Name:FOLTZ, LUBA MISHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LUBA
Middle Name:MISHELLE
Last Name:FOLTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LUBA
Other - Middle Name:MISHELLE
Other - Last Name:LANKEROVICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:805 MADISON ST STE 901
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-1172
Mailing Address - Country:US
Mailing Address - Phone:206-264-8100
Mailing Address - Fax:
Practice Address - Street 1:1101 MADISON ST STE 950
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3592
Practice Address - Country:US
Practice Address - Phone:206-682-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043428207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1004177Medicaid