Provider Demographics
NPI:1891965729
Name:BLANEY, ELAINE MARIE (DPM)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:MARIE
Last Name:BLANEY
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 FAIRFIELD WAY
Mailing Address - Street 2:SUITE 110
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108
Mailing Address - Country:US
Mailing Address - Phone:630-894-3000
Mailing Address - Fax:630-894-3050
Practice Address - Street 1:129 FAIRFIELD WAY
Practice Address - Street 2:SUITE 110
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108
Practice Address - Country:US
Practice Address - Phone:630-894-3000
Practice Address - Fax:630-894-3050
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT36997Medicare UPIN