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General NPI Number Information
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NPI Number | 1669521480
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Entity Type | Individual
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Provider Name | RICHARD BLANKS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 1802 S MATTIS AVE
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City | CHAMPAIGN
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State | IL
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Zip | 61821-5923
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Country | US
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Telephone | 217-383-1850
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Fax | 217-383-3439
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Provider Business Mailing Address
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Address Line | 611 W PARK ST FAPC
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City | URBANA
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State | IL
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Zip | 61801
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Country | US
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Telephone | 217-902-5292
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Fax |
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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 | 2084F0202X
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Taxonomy Name | Forensic Psychiatry Physician
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License Number | 223476
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License Number State | MA
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