Provider Demographics
NPI:1639117393
Name:GANDIS G MAZEIKA MD PS
Entity Type:Organization
Organization Name:GANDIS G MAZEIKA MD PS
Other - Org Name:SLEEP MEDICINE NORTHWEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GANDIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAZEIKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-636-2400
Mailing Address - Street 1:16150 NE 85TH ST STE 203
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3543
Mailing Address - Country:US
Mailing Address - Phone:425-636-2400
Mailing Address - Fax:425-636-2401
Practice Address - Street 1:21701 76TH AVE W STE 206
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7536
Practice Address - Country:US
Practice Address - Phone:425-636-2400
Practice Address - Fax:425-636-2401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000386959261QS1200X
WAMD00044962261QS1200X
WARN00103961261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1110972Medicaid
WAMD00038659OtherLICENSE NUMBER
WAMD00038659OtherLICENSE NUMBER