Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | MD00035206 | WA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | MD00035206 | WA |
NPI | 1063488856 |
---|---|
Provider Name | Michael K Belz |
First Address | Tacoma, WA 98405-4265 |
Second Address | Tacoma, WA 98405-4265 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 16/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0039571 | L & I (01) | WA |
806259600 | IDAHO MEDICAID (01) | WA |
8210338 | (05) | WA |
BE5191 | INDIVIDUAL BLUE SHIELD (01) | WA |
E48563 | (02) | |
MD5206 | ALASAKA DSHS (01) | WA |