MEDICARE: LUKE JOSEPH BLATNIK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WR0400X	Rehabilitation Registered Nurse	454638	OH

General Provider Information

NPI Number	:	1245888262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUKE JOSEPH BLATNIK

Provider Business Mailing Address
First Line	:	3367 CONCORD DR
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-3131
Country	:	US
Telephone Number	:	440-537-6425
Fax Number	:

Provider Business Practice Location Address
First Line	:	10701 EAST BLVD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1782
Country	:	US
Telephone Number	:	216-791-3800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/03/2019
Last Update Date	:	09/03/2019

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