Provider Demographics
NPI:1245381946
Name:DURTSCHI, MARTIN BOUSKA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:BOUSKA
Last Name:DURTSCHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 34876
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1876
Mailing Address - Country:US
Mailing Address - Phone:425-656-5412
Mailing Address - Fax:425-656-4096
Practice Address - Street 1:4033 TALBOT RD S
Practice Address - Street 2:STE 530
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5772
Practice Address - Country:US
Practice Address - Phone:425-228-6076
Practice Address - Fax:425-226-5224
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00016902208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDA04409Medicare UPIN