1811963713 NPI number — MS. SONDRA L BLOCKI MSPT

Table of content: MS. SONDRA L BLOCKI MSPT (NPI 1811963713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811963713 NPI number — MS. SONDRA L BLOCKI MSPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOCKI
Provider First Name:
SONDRA
Provider Middle Name:
L
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811963713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 MARQUETTE ROAD
Provider Second Line Business Mailing Address:
STE 111
Provider Business Mailing Address City Name:
PERU
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61354-1569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
815-220-8787
Provider Business Mailing Address Fax Number:
815-220-8790

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 MARQUETTE ROAD
Provider Second Line Business Practice Location Address:
STE 111
Provider Business Practice Location Address City Name:
PERU
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61354-1569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-220-8787
Provider Business Practice Location Address Fax Number:
815-220-8790
Provider Enumeration Date:
02/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 05032044 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201836513000 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".




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