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General NPI Number Information
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NPI Number | 1306395645
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Entity Type | Organization
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Legal Business Name | ROSENBLATT CLINIC LLC
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 09/28/2016
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Provider Practice Location Address
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Address Line | 4621 S SHRANK DR SUITE B
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City | INDEPENDENCE
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State | MO
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Zip | 64055-5453
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Country | US
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Telephone | 813-229-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 4621 S SHRANK DR SUITE B
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City | INDEPENDENCE
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State | MO
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Zip | 64055-5453
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Country | US
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Telephone | 813-229-3200
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Fax |
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Authorized Official
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Title or Position | DOCTOR OF OSTEOPATHY
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Name | DR. LEWIS ROSENBLATT
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Credential | D.O.
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Telephone | 816-229-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number | R7685
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License Number State | MO
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