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General NPI Number Information
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NPI Number | 1770932485
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Entity Type | Individual
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Provider Name | NICHOLAS EDWARD BLONIEN D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/03/2016
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Last Update Date | 08/22/2025
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Provider Practice Location Address
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Address Line | W129N7055 NORTHFIELD DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-0538
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Country | US
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Telephone | 262-253-5150
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Fax |
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Provider Business Mailing Address
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Address Line | W129N7055 NORTHFIELD DR
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City | MENOMONEE FALLS
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State | WI
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Zip | 53051-0538
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Country | US
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Telephone | 262-253-5150
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 68776
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2083P0500X
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Taxonomy Name | Preventive Medicine/Occupational Environmental Medicine Physician
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License Number | 81004
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License Number State | WI
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