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NPI Code Detail

MEDICARE: MR. REX ANDREW BLUNCK P.A.-C

MEDICARE: MR. REX ANDREW BLUNCK P.A.-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant10000288AIN

General Provider Information

NPI Number : 1215068556
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. REX ANDREW BLUNCK P.A.-C
Provider Business Mailing Address
First Line : 1932 S LAKEWOOD HLS
Second Line :
City : FRANCISCO
State : IN
Zip : 47649-9045
Country : US
Telephone Number : 812-782-9292
Fax Number : 812-387-2045
Provider Business Practice Location Address
First Line : 4000 TULIP TREE DR
Second Line : SS-I
City : PRINCETON
State : IN
Zip : 47670-2300
Country : US
Telephone Number : 812-387-2922
Fax Number : 812-387-2045
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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