Provider Demographics
NPI:1881798007
Name:BLYUMIN FOOT & ANKLE CLINIC LTD
Entity type:Organization
Organization Name:BLYUMIN FOOT & ANKLE CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR./OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEONID
Authorized Official - Middle Name:
Authorized Official - Last Name:BLYUMIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:773-743-5100
Mailing Address - Street 1:1405 W. MORSE AVE.
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60626
Mailing Address - Country:US
Mailing Address - Phone:773-743-5100
Mailing Address - Fax:773-743-0932
Practice Address - Street 1:1405 W. MORSE AVE.
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60626
Practice Address - Country:US
Practice Address - Phone:773-743-5100
Practice Address - Fax:773-743-0932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL016004759Medicaid
392430Medicare Oscar/Certification
U62203Medicare UPIN
IL016004759Medicaid
4730060001Medicare NSC