Individual
ERIC ANTHONY BLOEMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
206 N PEARL ST, TEUTOPOLIS, IL 62467-1134
(217) 857-6481
(217) 857-6094
Mailing address
PO BOX 19248, SPRINGFIELD, IL 62794-9248
(217) 528-7541
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036128692
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036128692
ILLINOIS LICENSE
IL
01
—
336090050
ILLINOIS CONTROLLED SUBSTANCE LICENSE
IL
05
—
371391171004
—
IL
01
—
561920
MEDICARE GROUP
IL
Enumeration date
07/06/2009
Last updated
03/07/2023
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