Provider Demographics
NPI:1801101555
Name:BLANKEMEIER, JULIE RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:RYAN
Last Name:BLANKEMEIER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7000 CERMAK RD
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-2112
Mailing Address - Country:US
Mailing Address - Phone:708-484-8090
Mailing Address - Fax:708-445-4444
Practice Address - Street 1:6703 S STEWART AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60621-3116
Practice Address - Country:US
Practice Address - Phone:773-834-2949
Practice Address - Fax:773-834-2953
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036084845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036384845Medicaid
367830Medicare PIN
ILF66437Medicare UPIN