Provider Demographics
NPI:1962490797
Name:BLAU, SIBEL (MD)
Entity Type:Individual
Prefix:
First Name:SIBEL
Middle Name:
Last Name:BLAU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SIBEL
Other - Middle Name:
Other - Last Name:KOC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1624 SOUTH I STREET
Mailing Address - Street 2:SUITE 305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-5093
Mailing Address - Country:US
Mailing Address - Phone:253-428-8700
Mailing Address - Fax:253-383-3376
Practice Address - Street 1:2920 SOUTH MERIDIAN
Practice Address - Street 2:SUITE 100
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-1428
Practice Address - Country:US
Practice Address - Phone:253-841-4296
Practice Address - Fax:253-841-2435
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037666207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8281875Medicaid
152929OtherL & I
152929OtherL & I
AB22376Medicare ID - Type Unspecified