Provider Demographics
NPI:1821046426
Name:BLEVINS, HAROLD W (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:W
Last Name:BLEVINS
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 1:3999 DUTCHMANS LN, SUITE #3A
Mailing Address - Street 2:SUBURBAN PLAZA ONE
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4714
Mailing Address - Country:US
Mailing Address - Phone:502-897-7300
Mailing Address - Fax:502-897-3332
Practice Address - Street 1:3999 DUTCHMANS LN, SUITE #3A
Practice Address - Street 2:SUBURBAN PLAZA ONE
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4714
Practice Address - Country:US
Practice Address - Phone:502-897-7300
Practice Address - Fax:502-897-3332
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16173207Y00000X
IN01053441A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000045754OtherANTHEM NUMBER
000000045754OtherUNICARE
2529793001OtherCIGNA NUMBER
5000416OtherWORKERS COMP
2351301OtherAETNA NUMBER
KY50000416OtherKENTUCKY PASSPORT #
KY50000416OtherPASSPORT NUMBER
610889380100OtherCARESOURCE
406031019OtherRAILROAD MEDICARE
KY64161730Medicaid
IN100007640BMedicaid
KY2442110000OtherPASSPORT ADVANTAGE
KY2442110000OtherPASSPORT ADVANTAGE
000000045754OtherANTHEM NUMBER
KYC70258Medicare UPIN
KY0655202Medicare PIN