Provider Demographics
NPI:1447345301
Name:BLUNT, CHAD MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:MICHAEL
Last Name:BLUNT
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 1:11697 W STATE ROUTE 163
Mailing Address - Street 2:
Mailing Address - City:OAK HARBOR
Mailing Address - State:OH
Mailing Address - Zip Code:43449-9113
Mailing Address - Country:US
Mailing Address - Phone:419-898-0993
Mailing Address - Fax:419-898-2444
Practice Address - Street 1:11697 W STATE ROUTE 163
Practice Address - Street 2:
Practice Address - City:OAK HARBOR
Practice Address - State:OH
Practice Address - Zip Code:43449-9113
Practice Address - Country:US
Practice Address - Phone:419-898-0993
Practice Address - Fax:419-898-2444
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-07-6808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH210217OtherANTHEM BCBS OF OHIO
OH2271616Medicaid
OHH39200Medicare UPIN
OHBL7288941Medicare ID - Type Unspecified
OHBL4102141Medicare PIN