Provider Demographics
NPI:1629096011
Name:BLITZ, ARIE (MD)
Entity Type:Individual
Prefix:
First Name:ARIE
Middle Name:
Last Name:BLITZ
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 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:254-202-9330
Mailing Address - Fax:
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 303
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8955
Practice Address - Country:US
Practice Address - Phone:254-202-0480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036139930208G00000X
OH35-086759208G00000X
VA0101268166208G00000X
TXQ2883208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3448474-01Medicaid
TX392317YN0EMedicare PIN
F32071Medicare UPIN
000000221017OtherUNISON
000000503669OtherANTHEM
363364OtherWELLCARE
735541OtherBUCKEYE
5564738OtherAETNA
OH2602848Medicaid
F32071Medicare UPIN