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General NPI Number Information
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NPI Number | 1134129588
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Entity Type | Individual
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Provider Name | ELIZABETH GAIL BLUNDEN MD
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Gender | Female
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Dates
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Enumeration Date | 07/28/2005
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 16815 E JEFFERSON AVE STE 120
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1923
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Country | US
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Telephone | 586-498-4400
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Fax | 586-498-4440
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Provider Business Mailing Address
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Address Line | DEPARTMENT 771036 P.O. BOX 77000
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City | DETROIT
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State | MI
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Zip | 48277-0001
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Country | US
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Telephone | 586-447-4171
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Fax | 586-447-4180
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 4301059826
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License Number State | MI
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