Provider Demographics
NPI:1134191745
Name:BLATT, GEOFFREY LEIGH (M D)
Entity type:Individual
Prefix:DR
First Name:GEOFFREY
Middle Name:LEIGH
Last Name:BLATT
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 E MEYER BLVD
Mailing Address - Street 2:SUITE 411
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64132-1132
Mailing Address - Country:US
Mailing Address - Phone:816-363-2500
Mailing Address - Fax:816-363-8741
Practice Address - Street 1:2330 E MEYER BLVD
Practice Address - Street 2:SUITE T411
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64132-1132
Practice Address - Country:US
Practice Address - Phone:816-363-2500
Practice Address - Fax:816-363-8741
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100668207T00000X
KS04-21025207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203410709Medicaid
KS100140560AMedicaid
MO2792336Medicare ID - Type Unspecified
KS100140560AMedicaid