Provider Demographics
NPI:1649326521
Name:DI BLASI, MICHELE (MD)
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:DI BLASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3809 VETERANS BLVD
Mailing Address - Street 2:
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-2860
Mailing Address - Country:US
Mailing Address - Phone:830-703-8555
Mailing Address - Fax:830-703-8334
Practice Address - Street 1:3809 VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-2860
Practice Address - Country:US
Practice Address - Phone:830-703-8555
Practice Address - Fax:830-703-8334
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7944207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX171252301Medicaid
TX8K9390OtherBCBS
TX171252301Medicaid
TX8K9390OtherBCBS
TX8C6037Medicare PIN