MEDICARE: MR. BLAKE SCOTT BUETOW DPT

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	2251X0800X	Orthopedic Physical Therapist	7587	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	052N1BU	OTHER		BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1811027980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BLAKE SCOTT BUETOW DPT

Provider Business Mailing Address
First Line	:	1155 COUNTY ROAD E E STE 120
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5191
Country	:	US
Telephone Number	:	651-241-1464
Fax Number	:

Provider Business Practice Location Address
First Line	:	1155 COUNTY ROAD E E STE 120
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55110-5191
Country	:	US
Telephone Number	:	651-241-1464
Fax Number	:

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	04/08/2020

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