Provider Demographics
NPI:1073742664
Name:BLOEMER, ERIC ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ANTHONY
Last Name:BLOEMER
Suffix:
Gender:M
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:PO BOX 19248
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62794-9248
Mailing Address - Country:US
Mailing Address - Phone:217-528-7541
Mailing Address - Fax:
Practice Address - Street 1:206 N PEARL ST
Practice Address - Street 2:
Practice Address - City:TEUTOPOLIS
Practice Address - State:IL
Practice Address - Zip Code:62467-1134
Practice Address - Country:US
Practice Address - Phone:217-857-6481
Practice Address - Fax:217-857-6094
Is Sole Proprietor?:No
Enumeration Date:2009-07-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036128692207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036128692OtherILLINOIS LICENSE
IL336090050OtherILLINOIS CONTROLLED SUBSTANCE LICENSE
IL371391171004Medicaid
IL561920OtherMEDICARE GROUP
IL561920OtherMEDICARE GROUP
148962Medicare Oscar/Certification