Provider Demographics
NPI:1669521480
Name:BLANKS, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:BLANKS
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 1:611 W PARK ST
Mailing Address - Street 2:FAPC
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801
Mailing Address - Country:US
Mailing Address - Phone:217-902-5292
Mailing Address - Fax:
Practice Address - Street 1:1802 S MATTIS AVE
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-5923
Practice Address - Country:US
Practice Address - Phone:217-383-1850
Practice Address - Fax:217-383-3439
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2234762084F0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ0024XOtherSC MEDICAID
NC1669521480OtherSANDHILLS
NC1669521480OtherUBH
NC1669521480OtherPARTNERS
NC1669521480Medicaid
NC277884OtherMEDCOST
NC9323083OtherAETNA
NC1669521480OtherCAROLINA BEHAVIORAL HEALTH ALL
NC185TNOtherBCBS
NC1669521480OtherTRICARE
NC1669521480OtherCENTERPOINT
NC3021917OtherUNITED HEALTHCARE
NC185TNOtherBCBS