Provider Demographics
NPI:1942357371
Name:BLANKAS HERNAEZ, NIDA B (MD)
Entity Type:Individual
Prefix:DR
First Name:NIDA
Middle Name:B
Last Name:BLANKAS HERNAEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NIDA
Other - Middle Name:B
Other - Last Name:HERNAEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:241 GOLF MILL CENTER
Mailing Address - Street 2:STE 200 GOLF MILL MEDICAL CENTER
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714
Mailing Address - Country:US
Mailing Address - Phone:847-297-4688
Mailing Address - Fax:847-297-4668
Practice Address - Street 1:241 GOLF MILL CENTER
Practice Address - Street 2:STE 200
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714
Practice Address - Country:US
Practice Address - Phone:847-297-4688
Practice Address - Fax:847-297-4668
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083674208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics