Provider Demographics
NPI:1316915325
Name:BLONSKI, JOSEPH M (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:BLONSKI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1555 NORTHWAY DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4913
Mailing Address - Country:US
Mailing Address - Phone:320-240-3157
Mailing Address - Fax:320-240-3143
Practice Address - Street 1:1555 NORTHWAY DRIVE
Practice Address - Street 2:SUITE 200
Practice Address - City:ST CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4913
Practice Address - Country:US
Practice Address - Phone:320-240-3157
Practice Address - Fax:320-240-3143
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-06-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MNMN37949207Q00000X
MN37949207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN212087900Medicaid
MN089000906Medicare ID - Type Unspecified
G12361Medicare UPIN