Blankenburg, Russell
Blankenburg, Russell is an individual health care provider with primary practice located at 17000 W North Ave Suite 200E, Brookfield WI 53005-4423. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Blankenburg, Russell can be contacted via phone (262) 782-4270.Contact Information
Primary practice address
17000 W North Ave Suite 200E
Brookfield WI 53005-4423
Phone: (262) 782-4270
Fax: (262) 784-9319
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 35536 | Wisconsin |
Profile Details
| NPI number | 1104893577 |
|---|---|
| LBN Legal business name | Blankenburg, Russell |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 3rd, 2006 |
| Last updated | Dec 7th, 2009 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1104893577 | NPPES |
| Wisconsin | MEDICAID | 32210000 |
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