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General NPI Number Information
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NPI Number | 1629266770
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Entity Type | Individual
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Provider Name | JEFFREY ALAN BLATNIK MD
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Gender | Male
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Dates
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Enumeration Date | 10/12/2007
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 4921 PARKVIEW PL DIV SURG MIS, STE 12B
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1032
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Country | US
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Telephone | 314-454-8877
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Fax | 877-991-4780
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-454-8877
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Fax | 877-991-4780
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 2015014712
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License Number State | MO
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