Healthcare Provider Details

I. General information

NPI: 1164427738
Provider Name (Legal Business Name): JOSEPH N BLUSTEIN M.D., MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2232 W LAWN AVE
MADISON WI
53711-1952
US

IV. Provider business mailing address

2232 W LAWN AVE
MADISON WI
53711-1952
US

V. Phone/Fax

Practice location:
  • Phone: 608-257-1866
  • Fax:
Mailing address:
  • Phone: 608-257-1866
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number29341
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number29341
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number29341
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: