Provider Demographics
NPI:1720043896
Name:BLINCHEVSKY, ALEXANDRA (MD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:BLINCHEVSKY
Suffix:
Gender:F
Credentials:MD
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:STE 350
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1835
Practice Address - Country:US
Practice Address - Phone:502-629-2030
Practice Address - Fax:502-629-2070
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35155207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1198325OtherCHA / CMA DBA
00000350750OtherANTHEM / CMA DBA
2439793000OtherPASSPORT ADVANTAGE / CMA DBA
IN200300830Medicaid
862381004OtherCIGNA / CMA DBA
KYP00181536OtherRAILROAD MEDICARE
000052152AOtherHUMANA / CMA DBA
017231OtherSIHO / CMA DBA
1163681OtherPASSPORT / CMA DBA
KY64019920Medicaid
00000350750OtherANTHEM / CMA DBA
2439793000OtherPASSPORT ADVANTAGE / CMA DBA