Provider Demographics
NPI:1295021921
Name:POLISHCHUK, ALEXEI L (MD)
Entity Type:Individual
Prefix:
First Name:ALEXEI
Middle Name:L
Last Name:POLISHCHUK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 W HORTON RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-7740
Mailing Address - Country:US
Mailing Address - Phone:360-370-2873
Mailing Address - Fax:360-818-2873
Practice Address - Street 1:381 W HORTON RD
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-7740
Practice Address - Country:US
Practice Address - Phone:360-370-2873
Practice Address - Fax:360-818-2873
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD606363092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G8953831Medicare PIN