Provider Demographics
NPI:1669450979
Name:BABUSIS, BENIS P (MD)
Entity type:Individual
Prefix:DR
First Name:BENIS
Middle Name:P
Last Name:BABUSIS
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 1:19020 33RD AVE W STE 210
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-4748
Mailing Address - Country:US
Mailing Address - Phone:425-563-1500
Mailing Address - Fax:425-563-1374
Practice Address - Street 1:19020 33RD AVE W STE 210
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-4748
Practice Address - Country:US
Practice Address - Phone:425-563-1500
Practice Address - Fax:425-563-1501
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-123132085R0202X
WAMD000395822085R0202X, 2085B0100X
AKS-49582085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1669450979Medicaid
WA189085OtherL&I PROVIDER NUMBER
AK1017303Medicaid
WA189083OtherL&I PROVIDER NUMBER
WA189093OtherL&I PROVIDER NUMBER
WA8286056Medicaid
WAG8857073Medicare PIN
WA8863816Medicare PIN
WA8857073Medicare PIN
WAG8887879Medicare UPIN
WAG8851488Medicare PIN
WAG8851486Medicare PIN
WA8857986Medicare PIN
WA189085OtherL&I PROVIDER NUMBER
WA189093OtherL&I PROVIDER NUMBER
WAH42470Medicare UPIN
WAG8857948Medicare PIN
WA8857948Medicare PIN
WAP00411651Medicare PIN