Healthcare Provider Details

I. General information

NPI: 1952383184
Provider Name (Legal Business Name): ELEANOR C BLITZER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 11/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1261 VISCAYA PKWY SUITE 101
CAPE CORAL FL
33990-3237
US

IV. Provider business mailing address

13740 CYPRESS TERRACE CIR
FORT MYERS FL
33907-8827
US

V. Phone/Fax

Practice location:
  • Phone: 239-573-7337
  • Fax: 239-574-6943
Mailing address:
  • Phone: 239-275-5522
  • Fax: 239-275-4464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME48956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: