Provider Demographics
NPI:1326142548
Name:BLYUMIN, LEONID (DPM)
Entity Type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:BLYUMIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 W MORSE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:773-743-5100
Mailing Address - Fax:773-743-0932
Practice Address - Street 1:1405 W MORSE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626
Practice Address - Country:US
Practice Address - Phone:773-743-5100
Practice Address - Fax:773-743-0932
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004759213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004759Medicaid
392430Medicare ID - Type Unspecified
U62203Medicare UPIN