Healthcare Provider Details

I. General information

NPI: 1457556417
Provider Name (Legal Business Name): PIERRE RENAUD BLEMUR JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2007
Last Update Date: 05/03/2022
Certification Date: 05/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N FAIRBANKS CT STE 4-500
CHICAGO IL
60611-3013
US

IV. Provider business mailing address

710 N FAIRBANKS CT STE 4-500
CHICAGO IL
60611-3013
US

V. Phone/Fax

Practice location:
  • Phone: 312-926-4880
  • Fax: 312-926-4885
Mailing address:
  • Phone: 312-926-4880
  • Fax: 312-926-4885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD.202476
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number036115764
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: