Provider Demographics
NPI:1750366209
Name:BLUMENTHAL, LEWIS S (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:S
Last Name:BLUMENTHAL
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 1:55 E WASHINGTON ST
Mailing Address - Street 2:SUITE 3700
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-2103
Mailing Address - Country:US
Mailing Address - Phone:312-263-5517
Mailing Address - Fax:312-263-5565
Practice Address - Street 1:55 E WASHINGTON ST
Practice Address - Street 2:SUITE 3700
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-2103
Practice Address - Country:US
Practice Address - Phone:312-263-5517
Practice Address - Fax:312-263-5565
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036059833207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036059833Medicaid
D13344Medicare UPIN