Provider Demographics
NPI:1376898270
Name:BLAVIN, YEHUDIS RIVKA (PA-C)
Entity Type:Individual
Prefix:MS
First Name:YEHUDIS
Middle Name:RIVKA
Last Name:BLAVIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:YEHUDIS
Other - Middle Name:RIVKA
Other - Last Name:TAWIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6777 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48322-3013
Mailing Address - Country:US
Mailing Address - Phone:248-325-1000
Mailing Address - Fax:248-325-1551
Practice Address - Street 1:6777 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3013
Practice Address - Country:US
Practice Address - Phone:248-325-1000
Practice Address - Fax:248-325-1551
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601009230363A00000X
NY015741363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant