MEDICARE: DR. ROBERT R. BLANCO 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	207RC0000X	Cardiovascular Disease Physician	036072218	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01621679	OTHER	IL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	316-03486	OTHER	IL	BCBS

General Provider Information

NPI Number	:	1487638805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT R. BLANCO M.D.

Provider Business Mailing Address
First Line	:	8752 KITTY LN
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1794
Country	:	US
Telephone Number	:	708-227-0756
Fax Number	:

Provider Business Practice Location Address
First Line	:	8752 KITTY LN
Second Line	:
City	:	HICKORY HILLS
State	:	IL
Zip	:	60457-1794
Country	:	US
Telephone Number	:	708-227-0756
Fax Number	:

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/22/2024

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