Healthcare Provider Details

I. General information

NPI: 1841581220
Provider Name (Legal Business Name): ALAN T BLANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 10/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 W HARRISON ST STE 300
CHICAGO IL
60612-4861
US

IV. Provider business mailing address

ONE WESTBROOK CORPORATE CENTER STE 240
WESTCHESTER IL
60154
US

V. Phone/Fax

Practice location:
  • Phone: 708-236-2600
  • Fax:
Mailing address:
  • Phone: 708-236-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number036143678
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number036143678
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: