Healthcare Provider Details

I. General information

NPI: 1235340449
Provider Name (Legal Business Name): DARIUS BLIZNIKAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2007
Last Update Date: 12/16/2021
Certification Date: 12/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7110 W 127TH ST SUITE 210
PALOS HEIGHTS IL
60463-1571
US

IV. Provider business mailing address

7110 W 127TH ST SUITE 210
PALOS HEIGHTS IL
60463-1571
US

V. Phone/Fax

Practice location:
  • Phone: 312-593-0886
  • Fax: 312-419-0547
Mailing address:
  • Phone: 312-593-0886
  • Fax: 312-419-0547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number01071829
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number10900
License Number StateND
# 3
Primary TaxonomyN
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License Number4301085256
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number036109618
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: