Provider Demographics
NPI:1083779342
Name:BLAHUT, JOSEPH (PA-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:BLAHUT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SOUTH 100 ROUTE 59
Mailing Address - Street 2:UNIT 6
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-9697
Mailing Address - Country:US
Mailing Address - Phone:630-416-8289
Mailing Address - Fax:630-416-8306
Practice Address - Street 1:4 SOUTH 100 ROUTE 59
Practice Address - Street 2:UNIT 6
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-9697
Practice Address - Country:US
Practice Address - Phone:630-416-8289
Practice Address - Fax:630-416-8306
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085002613363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK33731Medicare ID - Type UnspecifiedGROUP # 207851
ILQ73885Medicare UPIN
ILK33730Medicare ID - Type UnspecifiedGROUP # 207937