Basic Information
| Provider Information | |||||||||
| NPI: | 1720043896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLINCHEVSKY | ||||||||
| FirstName: | ALEXANDRA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 S FLOYD ST | ||||||||
| Address2: | STE 350 | ||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402021835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026292030 | ||||||||
| FaxNumber: | 5026292070 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 10/12/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/12/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35155 | KY | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1198325 | 01 | CHA / CMA DBA | OTHER | 00000350750 | 01 | ANTHEM / CMA DBA | OTHER | 2439793000 | 01 | PASSPORT ADVANTAGE / CMA DBA | OTHER | 200300830 | 05 | IN | MEDICAID | 862381004 | 01 | CIGNA / CMA DBA | OTHER | P00181536 | 01 | KY | RAILROAD MEDICARE | OTHER | 000052152A | 01 | HUMANA / CMA DBA | OTHER | 017231 | 01 | SIHO / CMA DBA | OTHER | 1163681 | 01 | PASSPORT / CMA DBA | OTHER | 64019920 | 05 | KY | MEDICAID |