Provider Demographics
NPI:1831129584
Name:BLACHAR, LEONARDO
Entity Type:Individual
Prefix:DR
First Name:LEONARDO
Middle Name:
Last Name:BLACHAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4090 NW 97TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2380
Mailing Address - Country:US
Mailing Address - Phone:305-477-7475
Mailing Address - Fax:305-477-2007
Practice Address - Street 1:4302 ALTON RD STE 580
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2876
Practice Address - Country:US
Practice Address - Phone:305-532-1989
Practice Address - Fax:305-532-8459
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47527207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL374545700Medicaid
FL09588ZMedicare ID - Type Unspecified
FL374545700Medicaid