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1487695219

NPI Code Detail

MEDICARE: KRISTINE A BLACKHAM MD

MEDICARE: KRISTINE A BLACKHAM MD

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	2085N0700X	Neuroradiology Physician	35084181	OH
2	2085B0100X	Body Imaging Physician	35084181	OH
3	2085D0003X	Diagnostic Neuroimaging (Radiology) Physician	35084181	OH
4	2085R0202X	Diagnostic Radiology Physician	35084181	OH
5	2085U0001X	Diagnostic Ultrasound Physician	35084181	OH
6	2085H0002X	Hospice and Palliative Medicine (Radiology) Physician	35084181	OH
7	2085N0904X	Nuclear Radiology Physician	35084181	OH
8	2085P0229X	Pediatric Radiology Physician	35084181	OH
9	2085R0001X	Radiation Oncology Physician	35084181	OH
10	2085R0203X	Therapeutic Radiology Physician	35084181	OH
11	2085R0204X	Vascular & Interventional Radiology Physician	35084181	OH
12	207U00000X	Nuclear Medicine Physician	35084181	OH
13	207UN0903X	In Vivo & In Vitro Nuclear Medicine Physician	35084181	OH
14	207UN0901X	Nuclear Cardiology Physician	35084181	OH
15	207UN0902X	Nuclear Imaging & Therapy Physician	35084181	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
7	P00358779	OTHER	OH	RAILROAD MEDICARE

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
2	732926	OTHER	OH	BUCKEYE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000000503569	OTHER	OH	ANTHEM
5	0304914	OTHER	OH	BCMH
6	751556	OTHER	OH	AETNA
8	000000206509	OTHER	OH	UNISON
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	363360	OTHER	OH	WELLCARE

General Provider Information

NPI Number	:	1487695219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE A BLACKHAM MD

Provider Business Mailing Address
First Line	:	24701 EUCLID AVE
Second Line	:	3RD FLOOR
City	:	EUCLID
State	:	OH
Zip	:	44117-1714
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11100 EUCLID AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44106-1736
Country	:	US
Telephone Number	:	216-844-1700
Fax Number	:	216-286-6341

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/27/2010

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Directions to “ KRISTINE A BLACKHAM MD” Practice Location

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