Provider Demographics
NPI:1770506255
Name:BLATT, STEPHEN N (MD)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:N
Last Name:BLATT
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 1:1605 NW 75TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-8391
Mailing Address - Country:US
Mailing Address - Phone:816-436-6660
Mailing Address - Fax:660-259-6813
Practice Address - Street 1:1500 STATE ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MO
Practice Address - Zip Code:64067-1107
Practice Address - Country:US
Practice Address - Phone:660-259-2203
Practice Address - Fax:660-259-6813
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6H4Y2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO540568508Medicaid
MO01089048OtherBCBS
MO202540365Medicaid
MOP270000Medicare PIN
MOP279651Medicare PIN
D16911Medicare UPIN