Provider Demographics
NPI:1770532988
Name:SEKOVSKI, BLAZE (MD)
Entity type:Individual
Prefix:DR
First Name:BLAZE
Middle Name:
Last Name:SEKOVSKI
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 1:500 W FORT ST
Mailing Address - Street 2:# 111
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-4501
Mailing Address - Country:US
Mailing Address - Phone:208-422-1325
Mailing Address - Fax:208-422-1319
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:# 111
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1325
Practice Address - Fax:208-422-1319
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY152495-1207RC0000X
IDM-16757207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY161000580OtherEMPIRE
NY01474139Medicaid
NY161000580OtherNOVA
NY0021748OtherGHI
NY2105974OtherIHA
NY00010161801OtherUNIVERA
NY110084830OtherRR MEDICARE
NY000505274002OtherHEALTH NOW
NY161000580OtherNORTH AMERICAN PREFERRED
NY161000580OtherAETNA