Provider Demographics
NPI:1114115037
Name:BLAKE H. HORIO, M.D., LTD
Entity Type:Organization
Organization Name:BLAKE H. HORIO, M.D., LTD
Other - Org Name:BLAKE H. HORIO, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:H
Authorized Official - Last Name:HORIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:630-734-2000
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60522-0643
Mailing Address - Country:US
Mailing Address - Phone:630-734-2000
Mailing Address - Fax:630-734-1090
Practice Address - Street 1:710 N YORK RD
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3555
Practice Address - Country:US
Practice Address - Phone:630-734-2000
Practice Address - Fax:630-734-1090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLAKE H. HORIO, M.D, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-04
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-090898207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL180028812OtherRAILROAD MEDICARE
IL036090898Medicaid
IL0001630006OtherBLUE CROSS BLUE SHIELD
IL250960Medicare PIN
IL0001630006OtherBLUE CROSS BLUE SHIELD