Provider Demographics
NPI:1326015009
Name:BLANK, ROBERT D (MD PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:BLANK
Suffix:
Gender:M
Credentials:MD PHD
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF ENDOCRINOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-955-6723
Mailing Address - Fax:414-955-6210
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF ENDOCRINOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-955-6723
Practice Address - Fax:414-955-6210
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI36590207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1326015009Medicaid
WIK400095756Medicare PIN
WI1326015009Medicaid