Provider Demographics
NPI:1194515759
Name:TEAM BLEVINS ENTERPRISES
Entity type:Organization
Organization Name:TEAM BLEVINS ENTERPRISES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:BLEVINS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:630-536-9077
Mailing Address - Street 1:309 KRISTEN ST
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:IL
Mailing Address - Zip Code:60545-1378
Mailing Address - Country:US
Mailing Address - Phone:630-536-9077
Mailing Address - Fax:
Practice Address - Street 1:246 E JANATA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5378
Practice Address - Country:US
Practice Address - Phone:630-536-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-07
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center