Provider Demographics
NPI:1386683712
Name:BLODGETT, MAURICE WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:MAURICE
Middle Name:WILLIAM
Last Name:BLODGETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:MAURICE
Other - Middle Name:WILLIAM
Other - Last Name:OELKLAUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:3200 GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50312
Mailing Address - Country:US
Mailing Address - Phone:515-271-1616
Mailing Address - Fax:
Practice Address - Street 1:8350 N CHURCH RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64158-1104
Practice Address - Country:US
Practice Address - Phone:877-337-7472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001013136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO245886908Medicaid
KS100642530 AMedicaid
MO245886924Medicaid
MO245886932Medicaid
MOP53B941Medicare ID - Type Unspecified
KS100642530 AMedicaid
MO245886932Medicaid