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General NPI Number Information
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NPI Number | 1730410010
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Entity Type | Organization
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Legal Business Name | BLEND INSTITUTE LLC
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Dates
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Enumeration Date | 01/26/2010
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Last Update Date | 04/04/2013
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Provider Practice Location Address
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Address Line | 1911 MANATEE AVE E SUITE 102
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City | BRADENTON
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State | FL
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Zip | 34208-1562
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Country | US
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Telephone | 941-722-5600
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Fax | 941-722-5644
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Provider Business Mailing Address
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Address Line | 1911 MANATEE AVE E SUITE 102
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City | BRADENTON
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State | FL
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Zip | 34208-1562
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Country | US
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Telephone | 941-722-5600
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Fax | 941-722-5644
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | TIMOTHY BLEND
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Credential | M.D.
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Telephone | 941-722-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME62136
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License Number State | FL
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