Provider Demographics
NPI:1952383184
Name:BLITZER, ELEANOR C (MD)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:C
Last Name:BLITZER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13740 CYPRESS TERRACE CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-8827
Mailing Address - Country:US
Mailing Address - Phone:239-275-5522
Mailing Address - Fax:239-275-4464
Practice Address - Street 1:1261 VISCAYA PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3237
Practice Address - Country:US
Practice Address - Phone:239-573-7337
Practice Address - Fax:239-574-6943
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME48956208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000013683BOtherHUMANA
FL046511900Medicaid
FL27095OtherSTAYWELL
FL02452OtherBC/BS OF FLORIDA
FL212021OtherAVMED
FL02452YMedicare ID - Type Unspecified
FL212021OtherAVMED