Provider Demographics
NPI:1164427738
Name:BLUSTEIN, JOSEPH N (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:N
Last Name:BLUSTEIN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2232 W LAWN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-1952
Mailing Address - Country:US
Mailing Address - Phone:608-257-1866
Mailing Address - Fax:
Practice Address - Street 1:2232 W LAWN AVE
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-1952
Practice Address - Country:US
Practice Address - Phone:608-257-1866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI29341207W00000X, 2084A0401X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI8280678OtherCIGNA
WV31426000Medicaid
WV31426000Medicaid
WVB51612Medicare UPIN
WI74459Medicare ID - Type Unspecified