Provider Demographics
NPI:1053476051
Name:BLUESTEIN, MARLENE (MD)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:BLUESTEIN
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 1:2325N WYATT DR 105
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2121
Mailing Address - Country:US
Mailing Address - Phone:520-324-2297
Mailing Address - Fax:520-324-1406
Practice Address - Street 1:5300 E. ERICKSON
Practice Address - Street 2:#116
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2809
Practice Address - Country:US
Practice Address - Phone:520-324-3940
Practice Address - Fax:520-324-3935
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13289207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C99163Medicare UPIN