MEDICARE: DR. DOROTHY KATHERINE BLONIARZ M.D.

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	207RR0500X	Rheumatology Physician	036129110	IL

General Provider Information

NPI Number	:	1841365939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOROTHY KATHERINE BLONIARZ M.D.

Provider Business Mailing Address
First Line	:	5325 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4104
Country	:	US
Telephone Number	:	773-283-5700
Fax Number	:	773-283-6450

Provider Business Practice Location Address
First Line	:	5325 W BELMONT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-4104
Country	:	US
Telephone Number	:	773-283-5700
Fax Number	:	773-283-6450

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

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	10/12/2012

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