Provider Demographics
NPI:1609391531
Name:JOSEPH BLUSTEIN, M.D. LLC
Entity Type:Organization
Organization Name:JOSEPH BLUSTEIN, M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:608-257-1866
Mailing Address - Street 1:2406 TREVOR WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53719-4663
Mailing Address - Country:US
Mailing Address - Phone:608-345-6741
Mailing Address - Fax:
Practice Address - Street 1:5555 ODANA RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53719-1240
Practice Address - Country:US
Practice Address - Phone:608-257-1866
Practice Address - Fax:888-249-0658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service