Provider Demographics
NPI:1619181120
Name:BLINT, ANDREW JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:JAY
Last Name:BLINT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1703
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61110-0203
Mailing Address - Country:US
Mailing Address - Phone:815-282-3700
Mailing Address - Fax:815-877-6415
Practice Address - Street 1:1235 N MULFORD RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61107-3879
Practice Address - Country:US
Practice Address - Phone:815-636-0700
Practice Address - Fax:815-904-6033
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2017-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.117808207X00000X, 207XX0801X
IL036-117808207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR02798Medicare PIN
IL036117808Medicaid