Individual
DR. RUSSELL BLANKENBURG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
17000 W NORTH AVE, SUITE 200E, BROOKFIELD, WI 53005-4423
(262) 782-4270
(262) 784-9319
Mailing address
17000 W NORTH AVE, BROOKFIELD, WI 53005-4423
(262) 782-4270
(262) 784-9319
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35536
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32210000
—
WI
Enumeration date
03/03/2006
Last updated
12/07/2009
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