Provider Demographics
NPI:1154983237
Name:WINTERTON, BLAINE MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:MICHAEL
Last Name:WINTERTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776084
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6084
Mailing Address - Country:US
Mailing Address - Phone:479-314-4620
Mailing Address - Fax:479-314-4630
Practice Address - Street 1:2713 S 74TH ST STE 301
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-5155
Practice Address - Country:US
Practice Address - Phone:479-314-4620
Practice Address - Fax:479-314-4630
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022021013207RP1001X
ARE-19090207RP1001X
MO2019021801207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine