Provider Demographics
NPI:1033146188
Name:CHAVERS, BLANCHE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLANCHE
Middle Name:MARIE
Last Name:CHAVERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE, MMC 491
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-626-2922
Mailing Address - Fax:612-626-2791
Practice Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - Street 2:516 DELAWARE STREET SE, PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-672-7122
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2012-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN24564208000000X, 2080P0210X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0210XAllopathic & Osteopathic PhysiciansPediatricsPediatric Nephrology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN31-24777OtherMEDICA CHOICE
MN31-74532OtherMEDICA PRIMARY
MNHP29186OtherHEALTHPARTNERS
MN2T269CHOtherBCBS
MN101071OtherUCARE
IA0990242Medicaid
MN1009067OtherPREFERRED ONE
MN689502600Medicaid
MN604711OtherARAZ
IA0990242Medicaid
MN370001535Medicare ID - Type UnspecifiedMN MEDICARE
MT0052130Medicare ID - Type UnspecifiedMT MA
MN31-24777OtherMEDICA CHOICE