Provider Demographics
NPI:1659466969
Name:BLASKI, MINDY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MINDY
Middle Name:L
Last Name:BLASKI
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 1:2023 26TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3043
Mailing Address - Country:US
Mailing Address - Phone:206-850-4232
Mailing Address - Fax:
Practice Address - Street 1:3216 NE 45TH PL STE 106
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-4028
Practice Address - Country:US
Practice Address - Phone:206-526-0210
Practice Address - Fax:206-526-0221
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00018121173000000X
CAG36982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1689405Medicaid
WA1689405Medicaid
WAA04093Medicare UPIN