Blatnik, Terra Rupert

Blatnik, Terra Rupert is an individual health care provider with primary practice located at 4921 Parkview Pl Ste 6A/6B/12A, Saint Louis MO 63110-1032. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Allopathic & Osteopathic Physicians / Pediatrics. Allopathic & Osteopathic Physicians / Sports Medicine is her primary health care specialty. Blatnik, Terra Rupert can be contacted via phone (314) 747-2551.

Contact Information

Primary practice address
4921 Parkview Pl Ste 6A/6B/12A Saint Louis MO 63110-1032
Phone: (314) 747-2551
Fax: (314) 747-2598
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 2015013430 Missouri
Allopathic & Osteopathic Physicians / Sports Medicine 2080S0010X 2015013430 Missouri
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 2015013430 Missouri

Profile Details

NPI number 1508066317
LBN Legal business name Blatnik, Terra Rupert
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 19th, 2007
Last updated Nov 15th, 2021 - about 5 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 1508066317 NPPES
Missouri MEDICAID 200023315

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