Provider Demographics
NPI:1043285042
Name:ROSENBLATT, LEWIS (DO)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4621 S SHRANK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5453
Mailing Address - Country:US
Mailing Address - Phone:816-229-3200
Mailing Address - Fax:816-503-8325
Practice Address - Street 1:4621 S SHRANK DR
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5453
Practice Address - Country:US
Practice Address - Phone:816-229-3200
Practice Address - Fax:816-503-8325
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR7685207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431873267OtherTAX ID NUMBER