Provider Demographics
NPI:1093971160
Name:BLATTAU, JAMES LEE
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:LEE
Last Name:BLATTAU
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:BLATTAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:59-199 KE NUI RD APT C
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-8723
Mailing Address - Country:US
Mailing Address - Phone:808-638-8427
Mailing Address - Fax:
Practice Address - Street 1:59-199 KE NUI RD APT C
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-8723
Practice Address - Country:US
Practice Address - Phone:808-638-8427
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-2745171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator