Blacker, Bruce A

Blacker, Bruce A is an individual health care provider with primary practice located at 2800 N Sheridan Rd Suite 400, Chicago IL 60657-6157. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Blacker, Bruce A can be contacted via phone (773) 472-5803.

Contact Information

Primary practice address
2800 N Sheridan Rd Suite 400 Chicago IL 60657-6157
Phone: (773) 472-5803
Fax: (773) 472-7902
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 036072584 Illinois

Profile Details

NPI number 1982603924
LBN Legal business name Blacker, Bruce A
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 20th, 2005
Last updated Oct 5th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1982603924 NPPES
Illinois MEDICAID 036072584

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