Provider Demographics
NPI:1306395645
Name:ROSENBLATT CLINIC LLC
Entity type:Organization
Organization Name:ROSENBLATT CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OSTEOPATHY
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-229-3200
Mailing Address - Street 1:4621 S SHRANK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-5453
Mailing Address - Country:US
Mailing Address - Phone:813-229-3200
Mailing Address - Fax:
Practice Address - Street 1:4621 S SHRANK DR
Practice Address - Street 2:SUITE B
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-5453
Practice Address - Country:US
Practice Address - Phone:813-229-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7685207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
L683767Medicare PIN
MOC51727Medicare UPIN