Basic Information
Provider Information
NPI: 1003011800
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLOMEIER
FirstName: HERMAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9977 WOODS DR
Address2:  
City: SKOKIE
State: IL
PostalCode: 600771057
CountryCode: US
TelephoneNumber: 8476638540
FaxNumber: 8476631015
Practice Location
Address1: 9977 WOODS DR
Address2:  
City: SKOKIE
State: IL
PostalCode: 600771057
CountryCode: US
TelephoneNumber: 8476638540
FaxNumber: 8476631015
Other Information
ProviderEnumerationDate: 06/20/2007
LastUpdateDate: 11/29/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RE0101X36111253ILY Allopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism

No ID Information.


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