MEDICARE: NATE S BLAUSTEIN M.D.

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
1	207P00000X	Emergency Medicine Physician	2000150983	MO
2	207P00000X	Emergency Medicine Physician	036-103815	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1437175387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATE S BLAUSTEIN M.D.

Provider Business Mailing Address
First Line	:	75 REMIT DR
Second Line	:	LOCKBOX 1374
City	:	CHICAGO
State	:	IL
Zip	:	60675-1374
Country	:	US
Telephone Number	:	866-916-5259
Fax Number	:	231-922-4030

Provider Business Practice Location Address
First Line	:	800 E CARPENTER ST
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62769-0002
Country	:	US
Telephone Number	:	217-544-6464
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	12/19/2021

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