Provider Demographics
NPI:1922076686
Name:BLUMENREICH, MARTIN S (MD)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:S
Last Name:BLUMENREICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 UNIVERSITY AVE W STE 110N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-2001
Mailing Address - Country:US
Mailing Address - Phone:651-602-5309
Mailing Address - Fax:651-222-6786
Practice Address - Street 1:560 S MAPLE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1733
Practice Address - Country:US
Practice Address - Phone:952-442-6606
Practice Address - Fax:952-442-6604
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN38112207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3612394OtherMEDICA
MN40B36BLOtherBLUE CROSS & BLUE SHIELD
MN01020430OtherPREFERRED ONE
MN115537OtherUCARE MN
MN844847OtherAMERICA'S PPO
MNHP24193OtherHEALTHPARTNERS
MN505875900Medicaid
MN3612394OtherMEDICA
MN505875900Medicaid
MNHP24193OtherHEALTHPARTNERS