Individual
TRISTAN DEE BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3991 DUTCHMANS LN STE 208, LOUISVILLE, KY 40207-4723
(502) 899-6061
(502) 899-6127
Mailing address
PO BOX 776351, CHICAGO, IL 60677-6351
(502) 588-9490
(502) 272-5116
Taxonomy
Speciality
Code
Description
License number
State
207RR0500X
Rheumatology Physician
Primary
46118
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201069110
—
IN
01
—
50052639
PASSPORT- NORTON RHEUMATOLOGY SPECIALISTS
KY
05
—
7100252740
—
KY
Enumeration date
04/24/2007
Last updated
11/17/2021
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