Individual
ANGEL BLAZQUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Mailing address
101 E MILLER RD, STERLING, IL 61081-1252
(815) 625-4790
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036085614
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036085614
—
IL
01
—
080149447
RAILROAD MEDICARE
—
Enumeration date
05/11/2006
Last updated
07/06/2021
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