Provider Demographics
NPI:1861479602
Name:BLANCHETT, MICHAEL G (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:BLANCHETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:3066 E COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78220-1013
Mailing Address - Country:US
Mailing Address - Phone:210-233-7074
Mailing Address - Fax:210-277-5199
Practice Address - Street 1:1102 BARCLAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-7161
Practice Address - Country:US
Practice Address - Phone:210-434-2368
Practice Address - Fax:210-434-0402
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXF1392207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040173901Medicaid
TX040173901Medicaid
TXC13523Medicare UPIN