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General NPI Number Information
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NPI Number | 1427243872
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Entity Type | Organization
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Legal Business Name | JENNIFER M. BLAIR, M.D., L.L.C.
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 11/12/2008
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Provider Practice Location Address
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Address Line | 2000 OGDEN AVE
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City | AURORA
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State | IL
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Zip | 60504-7222
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Country | US
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Telephone | 847-697-8868
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Fax |
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Provider Business Mailing Address
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Address Line | 192 MANSFIELD ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-3539
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Country | US
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Telephone | 312-282-5616
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Fax | 312-282-5616
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Authorized Official
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Title or Position | REGISTERED AGENT
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Name | DR. JENNIFER M BLAIR
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Credential | M.D.
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Telephone | 312-282-5616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 036117811
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License Number State | IL
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