Individual
KENNETH I BLUESTONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4500 MEMORIAL DR, BELLEVILLE, IL 62226-5360
(618) 257-4376
(618) 257-5196
Mailing address
PO BOX 23229, BELLEVILLE, IL 62223-0229
(618) 257-5050
(618) 233-1061
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
036138832
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00056031
RAILROAD MEDICARE
MO
Enumeration date
07/01/2005
Last updated
03/15/2021
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