Provider Demographics
NPI:1417130329
Name:BLAHUT, DONALD CHARLES
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:CHARLES
Last Name:BLAHUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 LARKIN AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60123-5888
Mailing Address - Country:US
Mailing Address - Phone:630-888-2526
Mailing Address - Fax:847-742-0191
Practice Address - Street 1:2050 LARKIN AVE STE 102
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-5888
Practice Address - Country:US
Practice Address - Phone:630-888-2526
Practice Address - Fax:847-742-0191
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL532730OtherMEDICARE PROVIDER ID