Provider Demographics
NPI:1184690539
Name:BLATT, MITCHELL E (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:E
Last Name:BLATT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1210 COUNTY ROAD E W
Practice Address - Street 2:
Practice Address - City:ARDEN HILLS
Practice Address - State:MN
Practice Address - Zip Code:55112-3783
Practice Address - Country:US
Practice Address - Phone:651-523-8400
Practice Address - Fax:651-484-9650
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN31248207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN746000700Medicaid