Provider Demographics
NPI:1568490050
Name:BLOUNT, CYNTHIA (DO)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BLOUNT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 N CENTER RD
Mailing Address - Street 2:STE 400
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-7920
Mailing Address - Country:US
Mailing Address - Phone:314-238-5260
Mailing Address - Fax:
Practice Address - Street 1:3400 N CENTER RD STE 400
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-7920
Practice Address - Country:US
Practice Address - Phone:989-753-9000
Practice Address - Fax:989-753-4024
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010110042085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI300E310060OtherBLUE CROSS
MI4344108Medicaid
MIN18560004Medicare ID - Type UnspecifiedMEDICARE
MI4344108Medicaid