Provider Demographics
NPI:1720173040
Name:LAKEVIEW FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:LAKEVIEW FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLASKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-526-0210
Mailing Address - Street 1:3216 NE 45TH PL STE 106
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-4028
Mailing Address - Country:US
Mailing Address - Phone:206-526-0210
Mailing Address - Fax:206-526-0221
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAA24096Medicare ID - Type Unspecified