Provider Demographics
NPI:1841217593
Name:ZIETAK, ALEKSANDRA M (MD)
Entity Type:Individual
Prefix:
First Name:ALEKSANDRA
Middle Name:M
Last Name:ZIETAK
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 1:13030 MILITARY RD S
Mailing Address - Street 2:STE 208
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-3085
Mailing Address - Country:US
Mailing Address - Phone:206-244-9551
Mailing Address - Fax:
Practice Address - Street 1:13030 MILITARY RD S
Practice Address - Street 2:STE 208
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-3085
Practice Address - Country:US
Practice Address - Phone:206-244-9551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20784208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB19041Medicare PIN