Healthcare Provider Details

I. General information

NPI: 1467927483
Provider Name (Legal Business Name): BLUEPRINT HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2018
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ANDOVER ST STE 205
NORTH ANDOVER MA
01845-5079
US

IV. Provider business mailing address

451 ANDOVER ST STE 205
NORTH ANDOVER MA
01845-5079
US

V. Phone/Fax

Practice location:
  • Phone: 978-983-2435
  • Fax: 781-480-1981
Mailing address:
  • Phone: 781-480-1976
  • Fax: 781-480-1981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AKINDELE MAJEKODUMNI
Title or Position: MANAGING PARTNER
Credential: MD
Phone: 267-779-5939